Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation
Chemoresistant or aggressive lymphoma predicts for a poor outcome following reduced-intensity allogeneic progenitor cell transplantation: an analysis from the Lymphoma Working Party of the European Group for Blood and Bone Marrow Transplantation
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DOI：
10.1182/blood-2001-11-0107
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发表时间：
2002-12-15
期刊：
影响因子：
20.3
通讯作者：
Schmitz, N
中科院分区：
文献类型：
--
作者：
Robinson, SP;Goldstone, AH;Schmitz, N
我们报告了来自欧洲血液和骨髓移植组 (EBMT) 淋巴瘤工作组的 188 名淋巴瘤患者的低强度同种异体祖细胞移植 (alloPCT) 的结果。患者的中位年龄为40岁，既往治疗疗程中位为3个，48%的患者曾接受过自体移植。 84% 的患者接受基于氟达拉滨的治疗方案，10% 的患者接受 BEAM（BCNU、依托泊苷、阿糖胞苷、美法仑）方案。在接受评估的 100 名患者中，71% 的患者得到了完全供体嵌合状态的证实。 37% 的患者出现急性移植物抗宿主病 (GVHD)，17% 的患者出现慢性 GVHD。 14 名患者中有 10 名出现了对供体白细胞输注 (DLI) 的疾病反应。中位随访时间为 283 天，1 年和 2 年总生存率分别为 62% 和 50%。 100 天和 1 年移植相关死亡率 (TRIM) 分别为 12.8% 和 25.5%，老年患者的死亡率明显更差。化疗耐药和化疗敏感疾病患者 1 年时疾病进展的概率分别为 75% 和 25% (P = .001)。 1 年无进展生存率为 46%，对于患有化疗敏感性疾病、霍奇金病 (HD) 和低度非霍奇金淋巴瘤 (NHL) 的患者来说，无进展生存率明显更高。患有高度 NHL、套细胞淋巴瘤或耐药性疾病的患者预后较差。降低强度的祖细胞移植与降低的 TRM 相关，并且可以控制晚期 HD 和低度 NHL。需要更长时间的随访来确定 DLI 的益处和移植物抗淋巴瘤效应。
We report the outcome of reduced-intensity allogeneic progenitor cell transplantation (alloPCT) for 188 patients with lymphoma from the Working Party Lymphoma of the European Group for Blood and Bone Marrow Transplantation (EBMT). The median age of the patients was 40 years, the median number of prior treatment courses was 3, and 48% of patients had undergone a prior autologous transplantation. Eighty-four percent of the patients received conditioning with fludarabine-based regimens and 10% with the BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) protocol. Full donor chimerism was confirmed in 71% of 100 patients assessed. Acute graft-versus-host disease (GVHD) developed in 37% of patients and chronic GVHD in 17%. A disease response to donor leukocyte infusion (DLI) was seen in 10 of 14 patients. With a median follow-up of 283 days, the overall survival rates at 1 and 2 years were 62% and 50%, respectively. The 100-day and 1-year transplantation-related mortality (TRIM) rates were 12.8% and 25.5%, respectively, and were significantly worse for older patients. The probability of disease progression at 1 year for patients with chemoresistant and chemosensitive disease were 75% and 25%, respectively (P = .001). The progression-free survival at 1 year was 46% and was significantly better for those with chemosensitive disease, Hodgkin disease (HD), and low-grade non-Hodgkin lymphoma (NHL). Patients with high-grade NHL, mantle cell lymphoma, or chemoresistant disease had a poor outcome. Reduced-intensity progenitor cell transplantation is associated with a reduced TRM and may control advanced HD and low-grade NHL. A longer period of follow-up is required to determine the benefit of DLI and the graft-versus-lymphoma effect.