Allogeneic hematopoietic stem cell transplantation provides sustained long-term survival for patients with adult T-cell leukemia/lymphoma
Allogeneic hematopoietic stem cell transplantation provides sustained long-term survival for patients with adult T-cell leukemia/lymphoma
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DOI：
10.1038/sj.leu.2403682
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发表时间：
2005-05-01
期刊：
影响因子：
11.4
通讯作者：
Tomonaga, M
中科院分区：
文献类型：
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作者：
Fukushima, T;Miyazaki, Y;Tomonaga, M
成人T细胞白血病/淋巴瘤（ATLL）是一种独特的外周T细胞肿瘤，对化疗高度耐药。包括我们在内的几个研究小组报告了ATLL患者的异基因造血干细胞移植（allo-HSCT）的令人鼓舞的结果。为了证实我们以前的报告，并建立一个II期临床研究的基础上，我们分析了40异基因造血干细胞移植的急性和淋巴瘤类型的ATLL在1997年和2002年之间在日本的七个机构。所有可评估病例均在allo-HSCT后进入完全缓解（CR），所有患者的中位生存期为9.6个月。估计的3年总生存率和无复发生存率以及疾病复发率分别为45.3%、33.8%和39.3%。在10例ATLL复发的病例中，5例再次达到CR：3例通过减少或停用免疫抑制剂，这表明了移植物抗ATLL（GvATLL）效应。然而，单因素或多因素分析均未显示移植物抗宿主病（GVHD）对预防复发有任何益处。这些结果表明，allo-HSCT对一些侵袭性ATLL患者有效，即使没有GVHD，也可以实现GvATLL效应。一项新的II期试验来测试allo-HSCT治疗ATLL的疗效是必要的。
Adult T-cell leukemia/lymphoma ( ATLL) is a distinct peripheral T-cell neoplasm that is highly resistant to chemotherapy. Several groups, including ours, have reported encouraging results of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for patients with ATLL. To confirm our previous report and to establish the basis for a phase II clinical study, we analyzed 40 allo-HSCT for acute and lymphoma types of ATLL in seven institutions in Japan between 1997 and 2002. All evaluable cases entered complete remission (CR) after allo-HSCT and the median survival time was 9.6 months for all patients. The estimated 3-year overall and relapse-free survival, and disease relapse were 45.3, 33.8 and 39.3%, respectively. Among 10 cases with ATLL relapse, five cases achieved CR again: three by the reduction or cessation of immunosuppressive agents, which suggested a graft-versus-ATLL (GvATLL) effect. However, univariate or multivariate analysis did not show any benefit of graft-versus-host disease (GVHD) on the prevention of relapse. These results suggested that allo-HSCT was effective for some patients with aggressive ATLL, and that the GvATLL effect could be achieved even without GVHD. A new phase II trial to test the efficacy of allo-HSCT for ATLL is warranted.