Allogeneic stem cell transplantation following reduced-intensity conditioning can induce durable clinical and molecular remissions in relapsed lymphomas: pre-transplant disease status and histotype heavily influence outcome
Allogeneic stem cell transplantation following reduced-intensity conditioning can induce durable clinical and molecular remissions in relapsed lymphomas: pre-transplant disease status and histotype heavily influence outcome
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DOI：
10.1038/sj.leu.2404822
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发表时间：
2007-11-01
期刊：
影响因子：
11.4
通讯作者：
Tarella, C.
中科院分区：
文献类型：
--
作者：
Corradini, P.;Dodero, A.;Tarella, C.
降低强度预处理（RIC）后进行异基因干细胞移植（SCT）治疗复发性淋巴瘤的安全性和有效性仍未得到解决。我们进行了一项前瞻性、多中心、II期试验。共有170例复发性/难治性淋巴瘤接受了RIC方案，随后接受了来自同胞供体的SCT。主要研究终点为非复发死亡率（NRM）。组织学为非霍奇金淋巴瘤（NHL）（惰性（LG-NHL），n = 63;侵袭性（HG-NHL），n = 61;套细胞淋巴瘤（MCL），n = 14）和霍奇金病（HD，n = 32）。中位随访时间为33个月（范围：12-82）。结果显示，发生率如下：3年时累积NRM为14%;急性和慢性移植物抗宿主病（GVHD）分别为35%和52%; 3年总生存率（OS），LG-NHL为69%，HG-NHL为69%，MCL为45%，HD为32 3年复发率分别为29%、31%、35%和81%（P < 0.001）。滤泡性淋巴瘤（FL）和慢性淋巴细胞白血病（CLL）3年后复发风险差异显著（14比46%，P = 0.04）。FL和CLL患者的分子缓解率分别为94%和40%（P = 0.002）。在多变量分析中，OS受化疗难治性疾病（风险比（HR）= 3.6）、HD诊断（HR = 3.5）和急性GVHD（HR = 5.9）的影响。RIC异基因SCT是治疗惰性和侵袭性NHL的可行和有效的挽救策略。
The safety and efficacy of reduced-intensity conditioning (RIC) followed by allogeneic stem cell transplantation (SCT) for relapsed lymphomas remains unresolved. We conducted a prospective, multicentered, phase II trial. A total of 170 relapsed/ refractory lymphomas received a RIC regimen followed by SCT from sibling donors. The primary study end point was non-relapse mortality (NRM). Histologies were non-Hodgkin's lymphomas (NHL) (indolent (LG-NHL), n = 63; aggressive (HG-NHL), n = 61; mantle cell lymphoma (MCL), n = 14) and Hodgkin's disease (HD, n = 32). Median follow-up was 33 months (range, 12-82). The results show that frequencies were as follows: cumulative NRM at 3 years, 14%; acute and chronic graft-versus-host disease (GVHD) 35 and 52%, respectively; 3-year overall survival (OS), 69% for LG-NHL, 69% for HG-NHL, 45% for MCL and 32% for HD (P = 0.058); and 3-year relapse incidence, 29, 31, 35 and 81%, respectively (P < 0.001). Relapse risk differed significantly at 3 years between follicular lymphoma (FL) and chronic lymphocytic leukemia (CLL) (14 versus 46%, P = 0.04). Molecular remission occurred in 94 and 40% (P = 0.002) of patients with FL and CLL, respectively. On multivariate analysis, OS was influenced by chemorefractory disease (hazard ratio (HR) = 3.6), diagnosis of HD (HR = 3.5), and acute GVHD (HR = 5.9). RIC allogeneic SCT is a feasible and effective salvage strategy in both indolent and aggressive NHL.