Graft-versus-lymphoma effect in relapsed peripheral T-cell non-Hodgkin's lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells
Graft-versus-lymphoma effect in relapsed peripheral T-cell non-Hodgkin's lymphomas after reduced-intensity conditioning followed by allogeneic transplantation of hematopoietic cells
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DOI：
10.1200/jco.2004.12.050
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发表时间：
2004-06-01
影响因子：
45.3
通讯作者：
Tarella, C
中科院分区：
文献类型：
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作者：
Corradini, P;Dodero, A;Tarella, C
目的。外周T细胞淋巴瘤(PTCL)是一组预后不良的异质性恶性肿瘤。我们进行了一项先导性研究，以调查在复发性或难治性PTCL中降低强度预适应(RIC)和同种异基因干细胞移植的作用。我们对17例患者进行了II期试验，这些患者接受了挽救化疗，随后进行了RIC和异基因造血细胞移植。RIC方案由硫替巴、氟达拉滨和环磷酰胺组成。急性移植物抗宿主病的预防包括环孢菌素和短程甲氨蝶呤。患者的平均年龄为41岁(范围为23至60岁)。2名患者为原发化疗耐药，15名患者复发；8名患者(47%)在自体移植后复发。经过平均28个月的随访(范围为3至57个月)，17名患者中有14人存活(12人完全缓解，1人部分缓解，1人病情稳定)，2人死于进展性疾病，1人死于急性移植物抗宿主病并发的败血症。3年总生存率和无进展生存率估计分别为81%(95%CI，62%~100%)和%(95%CI，39%~89%)。估计两年内无复发死亡的概率为6%(95%CI，1%~17%)。供者淋巴细胞输注引起2例异体移植后进展的患者出现反应。RIC联合异基因干细胞移植是可行的，与治疗相关的死亡率较低，似乎是一种有前途的复发性PTCL的抢救治疗方法。这些发现提示移植物抗T细胞淋巴瘤效应的存在。(C)2004年，由美国临床肿瘤学会提供。
Purpose. Peripheral T-cell lymphomas (PTCLs) are a heterogeneous group of malignancies characterized by a poor prognosis. We performed a pilot study to investigate the role of reduced-intensity conditioning (RIC) followed by allogeneic stem-cell transplantation in relapsed or refractory PTCLs.Patients and Methods. We have conducted a phase II trial on 17 patients receiving salvage chemotherapy followed by RIC and allogeneic transplantation of hematopoietic cells. The RIC regimen consisted of thiotepa, fludarabine, and cyclophosphamide. The acute graft-versus-host disease prophylaxis consisted of cyslosporine and short course methotrexate.Results. Patients had a median age of 41 years (range, 23 to 60 years). Two patients were primary chemorefractory, and 15 had relapsed disease; eight patients (47%) had a disease relapse after an autologous transplantation. After a median follow-up of 28 months from the day of study entry (range, 3 to 57 months), 14 of 17 patients were alive (12 in complete remission, one in partial remission, and one with stable disease), two died as a result of progressive disease, and one died as a result of sepsis concomitant to acute graft-versus-host disease. The estimated 3-year overall and progression-free survival rates were 81% (95% Cl, 62% to 100%) and 64% (95% Cl, 39% to 89%), respectively. The estimated probability of nonrelapse mortality at 2 years was 6% (95% Cl, 1% to 17%). Donor lymphocyte infusions induced a response in two patients progressing after allografting.Conclusion. RIC followed by allogeneic stem-cell transplantation is feasible, has a low treatment-related mortality, and seems to be a promising salvage treatment for relapsed PTCL. These findings suggest that the existence of a graft-versus-T-cell lymphoma effect. (C) 2004 by American Society of Clinical Oncology.