Allogeneic hematopoietic cell transplantation after fludarabine and 2 Gy total body irradiation for relapsed and refractory mantle cell lymphoma
Allogeneic hematopoietic cell transplantation after fludarabine and 2 Gy total body irradiation for relapsed and refractory mantle cell lymphoma
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DOI：
10.1182/blood-2004-06-2275
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发表时间：
2004-12-01
期刊：
影响因子：
20.3
通讯作者：
Maloney, DG
中科院分区：
文献类型：
--
作者：
Maris, MB;Sandmaier, BM;Maloney, DG
我们对33例复发性和难治性套细胞淋巴瘤患者在氟达拉滨非清髓预处理和2戈伊全身照射后进行了HLA匹配的相关（n = 16）和非相关（n = 17）造血细胞移植（HCT）。移植后免疫抑制剂包括环孢素和霉酚酸酯。14例患者高剂量自体HCT失败。在研究的33例患者中，31例植入稳定，2例发生非致死性移植物排斥反应。急性II、III、IV级和慢性移植物抗宿主病（GVHD）的发生率分别为27%、17%、13%和64%。HCT时20例可测量疾病患者的总体缓解率为85%（n = 17; 75%完全缓解[CR]和10%部分缓解[PR]），而3例患者疾病进展。17名有反应的患者中只有1名患者，13名接受CR移植的患者中没有一名患者出现疾病复发，中位随访时间为24.6个月。2年时复发和非复发死亡率分别为9%和24%。Kaplan-Meier估计的2年总生存率和无病生存率分别为65%和60%。非成髓细胞性预处理后的异基因HCT是复发性和难治性套细胞淋巴瘤患者的一种有希望的挽救策略。这种方法的高反应率和低复发率表明套细胞淋巴瘤对移植物抗肿瘤反应敏感。(C)2004年，美国血液学会。
We carried out HLA-matched related (n = 16) and unrelated (n = 17) hematopoietic cell transplantation (HCT) in 33 patients with relapsed and refractory mantle cell lymphoma after nonmyeloablative conditioning with fludarabine and 2 Gy total body irradiation. Postgrafting immunosuppression consisted of cyclosporine and mycophenolate mofetil. Fourteen patients had failed high-dose autologous HCT. Of the 33 patients studied, 31 had stable engraftment, whereas 2 patients experienced nonfatal graft rejections. The incidences of acute grades II, III, and IV, and chronic graft-versus-host disease (GVHD) were 27%,17%,13%, and 64%, respectively. The overall response rate in the 20 patients with measurable disease at the time of HCT was 85% (n = 17; 75% complete remissions [CR] and 10% partial remissions [PR]), whereas 3 patients had progressive disease. Only one of the 17 patients who responded and none of the 13 who received transplants in CR had disease relapse with a median follow-up of 24.6 months. Relapse and nonrelapse mortalities were 9% and 24%, respectively, at 2 years. The Kaplan-Meier probabilities of overall and disease-free survivals at 2 years were 65% and 60%, respectively. Allogeneic HCT after nonmyeloalblative conditioning is a promising salvage strategy for patients with relapsed and refractory mantle cell lymphoma. The high response and low relapse rates with this approach suggest that mantle cell lymphoma is susceptible to graft-versus-tumor responses. (C) 2004 by The American Society of Hematology.