Allogeneic Hematopoietic Cell Transplantation for Patients With Mycosis Fungoides and Sezary Syndrome: A Retrospective Analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
Allogeneic Hematopoietic Cell Transplantation for Patients With Mycosis Fungoides and Sezary Syndrome: A Retrospective Analysis of the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
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DOI：
10.1200/jco.2010.29.3241
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发表时间：
2010-10-10
影响因子：
45.3
通讯作者：
Sureda, Anna
中科院分区：
文献类型：
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作者：
Duarte, Rafael F.;Canals, Carmen;Sureda, Anna
目的分析同种异体移植治疗蕈样肉芽肿和Sezary综合征（MF/SS）的非复发死亡率（NRM）、复发/进展（REL）、无进展生存期（PFS）、患者和方法60例MF（n = 36）和SS（n = 24）患者，均为非典型肺炎（non-smoking，non-smoking）患者。从匹配的亲属接受第一次异基因造血细胞移植（HCT）（mRD; n = 45）或无关供体对1997年至2007年期间在欧洲血液和骨髓移植组数据库中注册的15例（mUD; n = 15）患者进行了分析：37例男性和23例女性，中位年龄46.5岁（范围：22 - 66岁）。44例患者为TNM IV期，40例患者在移植时处于晚期。44例患者接受降低强度预处理（RIC）方案，25例接受T细胞耗竭（TCD）。结果同种异体移植MF/SS提供了一个估计的OS为66%，在1年和54%，在3年，主要由捐助者类型，疾病阶段，和类型的调节。RIC降低NRM（相对风险[RR] = 4.7; P=.008），而不增加REL，导致OS更高（RR = 2.8; P=.03）。晚期疾病增加REL（RR=3.0; P= 0.03），降低PFS（RR=4.4; P= 0.002）和OS（RR=3.5; P= 0.023）。mRD同种异体HCT的接受者的PFS（RR=2.7; P= 0.006）和OS（RR=4.0; P= 0.001）优于其mUD对应者。经颅多普勒超声（TCD）检查，REL的风险增加（RR=3.2; P= 0.005）。一些复发的患者可以成功地进行救援治疗与供者淋巴细胞infrations.Conclusion异基因移植是一种有效的治疗方案，为高危患者晚期MF/SS。我们的数据还表明MF/SS中存在临床相关的移植物抗淋巴瘤效应。J Clin Oncol 28：4492-4499. (C)2010年美国临床肿瘤学会
Purpose To analyze the outcome of allogeneic transplantation for mycosis fungoides and Sezary syndrome (MF/SS) in terms of nonrelapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) and to identify factors associated with the outcome.Patient and Methods Sixty patients with MF (n = 36) and SS (n = 24) who received a first allogeneic hematopoietic cell transplantation (HCT) from a matched related (mRD; n = 45) or unrelated donor (mUD; n = 15) between 1997 and 2007 and who were registered in the European Group for Blood and Marrow Transplantation database were analyzed: 37 men and 23 women, median age 46.5 years (range, 22 to 66 years). Forty-four patients had TNM stage IV, and 40 patients were at advanced phase at transplantation. Forty-four patients received reduced-intensity conditioning (RIC) regimens, and 25 underwent T-cell depletion (TCD).Results Allogeneic transplantation in MF/SS offers an estimated OS of 66% at 1 year and 54% at 3 years, primarily driven by donor type, disease phase, and type of conditioning. RIC decreased NRM (relative risk [RR] = 4.7; P=.008) without increasing REL, leading to a higher OS (RR = 2.8; P=.03). Advanced-phase disease increases REL (RR=3.0; P=.03) and reduces PFS (RR=4.4; P=.002) and OS (RR=3.5; P=.023). Recipients of mRD allogeneic HCT had better PFS (RR=2.7; P=.006) and OS (RR=4.0; P=.001) than their mUD counterparts. The risk of REL increases with TCD (RR=3.2; P=.005). Some patients who experience relapse can successfully undergo rescue treatment with donor lymphocyte infusions.Conclusion Allogeneic transplantation is a valid therapeutic alternative for high-risk patients with advanced-stage MF/SS. Our data also suggest the existence of a clinically relevant graft-versus-lymphoma effect in MF/SS. J Clin Oncol 28:4492-4499. (C) 2010 by American Society of Clinical Oncology