Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning
Relapse risk in patients with malignant diseases given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning
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DOI：
10.1182/blood-2007-03-078592
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发表时间：
2007-10-01
期刊：
影响因子：
20.3
通讯作者：
Storb, Rainer
中科院分区：
文献类型：
--
作者：
Kahl, Christoph;Storer, Barry E.;Storb, Rainer
非清髓性预处理后的异基因造血细胞移植（HCT）治疗恶性血液病取决于移植物抗肿瘤效应以根除癌症。在这里，我们根据疾病特征估计复发风险。在1997年至2006年期间，834名连续患者（中位年龄55岁;范围5-74岁）在2戈伊全身照射后单独（n = 171）或联合氟达拉滨（go mg/m2; n = 663）接受相关（n = 498）或不相关（n = 336）HCT。计算了29种不同疾病和分期的每患者年（PY）风险复发率（经随访和竞争性非复发死亡率校正）。每PY的总体复发率为0.36。慢性淋巴细胞白血病（CLL）和多发性骨髓瘤（MM）缓解期（CR）、低度或套细胞非霍奇金淋巴瘤（NHL）（CR +部分缓解[PR]）和高度NHL-CR患者的发生率最低（0.00-0.24;低风险）。相比之下，晚期骨髓和淋巴恶性肿瘤患者的比率超过0.52（高风险）。未达到CR的淋巴增生性疾病（霍奇金淋巴瘤和高度NHL除外）和髓系恶性肿瘤患者达到CR的发生率为0.26-0.37（标准风险）。总之，低度淋巴增生性疾病患者的复发率最低，而晚期髓系和淋巴恶性肿瘤患者在非髓白性HCT后的复发率较高。后者可能受益于HCT前的细胞减灭治疗。
Allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning for hematologic malignancies depends on graft-versus-tumor effects for eradication of cancer. Here, we estimated relapse risks according to disease characteristics. Between 1997 and 2006,834 consecutive patients (median age, 55 years; range, 5-74 years) received related (n = 498) or unrelated (n = 336) HCT after 2 Gy total body irradiation alone (n = 171) or combined with fludarabine (go mg/m(2); n = 663). Relapse rates per patient year (PY) at risk, corrected for follow-up and competing nonrelapse mortality, were calculated for 29 different diseases and stages. The overall relapse rate per PY was 0.36. Patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM) in remission (CR), low-grade or mantle cell non-Hodgkin lymphoma (NHL) (CR + partial remission [PR]), and high-grade NHL-CR had the lowest rates (0.00-0.24; low risk). In contrast, patients with advanced myeloid and lymphoid malignancies had rates of more than 0.52 (high risk). Patients with lymphoproliferative diseases not in CR (except Hodgkin lymphoma and high-grade NHL) and myeloid malignancies in CR had rates of 0.26-0.37 (standard risk). In conclusion, patients with low-grade lymphoproliferative disorders experienced the lowest relapse rates, whereas patients with advanced myeloid and lymphoid malignancies had high relapse rates after nonmyeloalbative HCT. The latter might benefit from cytoreductive treatment before HCT.