Allogeneic transplants in follicular lymphoma: Higher risk of disease progression after reduced-intensity compared to myeloablative conditioning
Allogeneic transplants in follicular lymphoma: Higher risk of disease progression after reduced-intensity compared to myeloablative conditioning
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DOI：
10.1016/j.bbmt.2007.11.004
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发表时间：
2008-02-01
影响因子：
4.3
通讯作者：
van Besien, Koen
中科院分区：
文献类型：
--
作者：
Hari, Parameswaran;Carreras, Jeanette;van Besien, Koen
降低强度预处理（RIC）方案已越来越多地用于滤泡性淋巴瘤（FL）的异基因造血干细胞移植（HSCT）。我们比较了传统的清髓性预处理方案，以RIC在FL。结果HLA相同的同胞HSCT FL在1997年至2002年之间报告给国际血液和骨髓移植研究中心（CIBMTR）的208名受者进行了研究。预处理方案分为清髓性（N = 120）或RIC（N = 88）。RIC方案的使用从< 10% of transplants in 1997 to >2002年的80%增加，标志着实践的重大转变。接受RIC的患者年龄较大，从诊断到移植的间隔较长。这些差异与结果无关。存活者的中位随访时间为清髓性预处理后50个月（4-96个月），而RIC后为35个月（4-82个月）（P <0.001）。在3年时，清髓性和RIC队列的总生存率（OS）分别为71（63%-79%）和。62例（51%-72%; P = .15）和无进展生存期（PFS）分别为67例（58%-75%）和55例（44%-65%; P = .07）。较低的Karnofsky体能评分（KPS）和化疗耐药与较高的治疗相关死亡率（TRM）和较低的OS和PFS相关。在多变量分析中，观察到RIC后淋巴瘤进展的风险增加（相对风险= 2.97，P = 0.04）。RIC已成为FL同种异体HSCT的事实标准，并且似乎导致类似的长期结局。尽管无病生存期（DPS）与清髓性预处理相似，但RIC后晚期疾病进展的风险增加值得关注（c）2008年美国血液和骨髓移植学会。
Reduced-intensity conditioning (RIC) regimens have been increasingly used for allogeneic hematopoietic stem cell transplantation (HSCT) in follicular lymphoma (FL). We compared traditional myeloablative conditioning regimens to RIC in FL. Outcomes of HLA-identical sibling HSCT for FL in 208 recipients reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) between 1997 and 2002 were studied. Conditioning regimens were categorized as myeloablative (N = 120) or RIC (N = 88). Use of RIC regimens increased from < 10% of transplants in 1997 to > 80% in 2002 signaling a major shift in practice. Patients receiving RIC were older and had a longer interval from diagnosis to transplant. These differences did not correlate with outcomes. Median follow-up of survivors was 50 months (4-96 months) after myeloablative conditioning versus 35 months (4-82 months) after RIC (P < .001). At 3 years, overall survival (OS) for the myeloablative and RIC cohorts were 71 (63%-79%) and. 62 (51%-72%; P = .15) and progression free survival (PFS), 67 (58%-75%) and 55 (44%-65%; P = .07), respectively. Lower Karnofsky performance score (KPS) and resistance to chemotherapy were associated with higher treatment-related mortality (TRM) and lower OS and PFS. On multivariate analysis, an increased risk of lymphoma progression after RIC was observed (relative risk = 2.97, P = .04). RIC has become the de facto standard in allogeneic HSCT for FL, and appears to result in similar long-term outcomes. Although disease-free survival (DPS) is similar compared to myeloablative conditioning, an increased risk of late disease progression after RIC is concerning (c) 2008 American Society for Blood and Marrow Transplantation.