High Rate of Long-Term Survival for High-Risk Lymphoma Patients Treated With Hematopoietic Stem Cell Transplantation as Consolidation or Salvage Therapy
High Rate of Long-Term Survival for High-Risk Lymphoma Patients Treated With Hematopoietic Stem Cell Transplantation as Consolidation or Salvage Therapy
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DOI：
10.1016/j.transproceed.2008.08.092
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发表时间：
2008-11-01
影响因子：
0.9
通讯作者：
Urbano-Ispizua, A.
中科院分区：
文献类型：
--
作者：
Espigado, I.;Rios, E.;Urbano-Ispizua, A.
高复发风险淋巴瘤患者或初始治疗后复发的患者采用常规治疗治愈的可能性有限。最近有非决定性的证据表明，在这种情况下，强化或挽救治疗与高剂量化疗后造血干细胞移植（HSCT）增加的反应率，并可能提高生存。然而，关于HSCT治疗高危淋巴瘤患者的长期随访的已发表数据很少。我们分析了101例连续接受高剂量化疗的患者，在标准化疗诱导后接受HSCT。中位年龄为38岁（范围：12-63岁）。诊断为霍奇金病（n = 32），滤泡性淋巴瘤（n = 33），弥漫性大B细胞淋巴瘤（n = 12），套细胞淋巴瘤（n = 7），T细胞淋巴瘤（n = 14）和其他（n = 3）。患者在首次完全缓解（1CR; n = 23）或晚期（AS; n = 49）时接受自体移植（n = 72），或在1CR（n = 7）或AS（n = 22）时接受同种异体移植（n = 29）。我们得出结论，接受自体HSCT的患者的移植相关死亡率为2.7%，接受同种异体HSCT的患者为27%。主要病因是同种异体移植物抗宿主病和感染，以及自体移植物感染。长期（12年）总生存率为71%，高于未经HSCT治疗的高复发风险淋巴瘤患者，且显著优于（P
Patients with high-relapse-risk lymphomas or those relapsing after initial therapy have a limited probability of cure with conventional treatment. There is recent inconclusive evidence that, in such cases, intensification or salvage treatment with high-dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) increases the response rate and may improve survival. Nevertheless, published data on long-term follow-up of high-risk lymphoma patients treated with HSCT are scarce. We analyzed 101 consecutive patients receiving high-dose chemotherapy followed by HSCT after induction with standard chemotherapy. The median age was 38 years (range, 12-63 years). The diagnoses were Hodgkin's disease (n = 32), follicular lymphoma (n = 33), diffuse large B-cell lymphoma (n = 12), mantle cell lymphoma (n = 7), T-cell lymphoma (n = 14), and others (n = 3). Patients received either an autologous graft (n = 72) in first complete remission (1CR; n = 23) or in advanced stages (AS; n = 49), or an allogeneic graft (n = 29) in 1CR (n = 7) or in AS (n = 22). We concluded that transplant-related mortality was 2.7% for patients receiving an autologous HSCT and 27% for patients receiving an allogeneic HSCT. The main etiologies were graft-versus-host disease and infection in the allogeneic setting, and infection in the autologous setting. The probability of long-term (12-year) overall survival was 71%, higher than that described for high-relapse-risk lymphoma patients treated without HSCT and significantly better (P