Nonmyeloablative allogeneic hematopoietic transplantation:: A promising salvage therapy for patients with non-Hodgkin's lymphoma whose disease has failed a prior autologous transplantation
Nonmyeloablative allogeneic hematopoietic transplantation:: A promising salvage therapy for patients with non-Hodgkin's lymphoma whose disease has failed a prior autologous transplantation
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DOI：
10.1200/jco.2004.09.092
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发表时间：
2004-06-15
影响因子：
45.3
通讯作者：
Khouri, IF
中科院分区：
文献类型：
--
作者：
Escal贸n, MP;Champlin, RE;Khouri, IF
淋巴瘤患者自体移植后复发的异基因移植被认为是一种危险的治疗选择。我们调查了非清髓性干细胞移植在这些patients.Patients和MethodsPatients的安全性和有效性，需要有化疗敏感或稳定的疾病。在两项连续试验中治疗了20例连续患者。15例患者接受了氟达拉滨（30 mg/m2，每日1次，共3天）、环磷酰胺（750 mg/m2，每日1次，共3天）和利妥昔单抗的准备方案。对于其余5例患者，预处理方案包括顺铂（25 mg/m2，每日连续输注4天）、氟达拉滨（30 mg/m2，每日持续2天）和阿糖胞苷（1，000 mg/m2，每日持续2天）。他克莫司和甲氨蝶呤用于预防移植物抗宿主病。结果所有患者均经历了供体细胞植入，1例患者（5%）出现2级急性移植物抗宿主病，没有患者出现更高级别的移植物抗宿主病。1例患者在移植后115天出现疾病进展，并对供体淋巴细胞输注有反应。其余患者保持无疾病状态。1例患者在10.5个月时死于真菌感染。中位随访时间为25个月，3年无进展生存率为95%。结论非清髓性异基因造血干细胞移植是治疗化疗敏感或病情稳定的淋巴瘤患者自体移植后复发的有效选择。(C)2004年，美国临床肿瘤学会。
PurposeAllogeneic transplantation for patients with lymphoma who experience a recurrence after an autologous transplantation has been considered a hazardous therapeutic choice. We investigated the safety and efficacy of nonmyeloablative stem-cell transplantation in these patients.Patients and MethodsPatients were required to have chemosensitive or stable disease. Twenty consecutive patients were treated in two sequential trials. Fifteen patients underwent a preparative regimen of fludarabine (30 mg/m(2) daily for 3 days), intravenous cyclophosphamide (750 mg/m(2) daily for 3 days), and rituximab. For the remaining five patients, the conditioning regimen consisted of cisplatin (25 mg/m(2) continuous infusion daily for 4 days), fludarabine (30 mg/m(2) daily for 2 days), and cytarabine (1,000 mg/m(2) daily for 2 days). Tacrolimus and methotrexate were used for graft-versus-host disease prophylaxis.ResultsAll patients experienced engraftment of donor cells, One patient (5%) experienced grade 2 acute graft-versus-host disease, and no patients experienced a higher grade. One patient experienced disease progression at 115 days post-transplantation and responded to donor lymphocyte infusion. The remaining patients remained disease-free. One patient died at 10.5 months from a fungal infection. With a median follow-up time of 25 months, the estimated 3-year current progression-free survival rate was 95%.ConclusionThese data suggest that nonmyeloablative allogeneic stem-cell transplantation is an effective option in lymphoma patients with chemosensitive or stable disease who experience disease recurrence following autologous transplantation. (C) 2004 by American Society of Clinical Oncology.