Current status of allogeneic transplantation for aggressive non-Hodgkin lymphoma.
Current status of allogeneic transplantation for aggressive non-Hodgkin lymphoma.
复制标题
DOI：
10.1097/cco.0b013e32834bb88e
复制
发表时间：
2011-11
影响因子：
3.4
通讯作者：
van Besien K
中科院分区：
文献类型：
--
作者：
van Besien K
提供一个关于异基因干细胞移植在侵袭性淋巴瘤患者治疗中的作用的简要更新。阐明同种异体移植维斯自体移植的适应症，并讨论降低强度预处理（RIC）、非清髓性（NMA）移植、T细胞耗竭和GVHD预防变化的合理性和潜在获益。在开发具有降低的毒性和降低的GVHD的移植方案方面已经花费了相当大的努力。根据淋巴瘤分类、诊断方法，特别是PET扫描和移植技术的进步，同种异体移植的作用也被重新定义。Haplo和UCB SCT可以为几乎所有患者确定供体。RIC和NMA预处理降低了早期毒性，但与疾病复发风险增加相关。一种新型预处理方案（将NMA与替伊莫单抗联合使用）报告了有希望的数据。T细胞耗竭减少了cGVHD，但复发率有所增加。雷帕霉素可能与降低疾病复发风险有关。在弥漫性大B细胞淋巴瘤中，allo SCT的结果取决于患者的特征和化疗敏感性。在autoSCT失败后和挽救治疗的部分反应中是安全的。Allo SCT可能是晚期T细胞和NK细胞淋巴瘤以及ATLL的治疗选择。预防性或先发制人的DLI可能是有用的，但需要对照研究。
To provide a succinct update on the role of allogeneic stem cell transplantation in the management of patients with aggressive lymphomas. To clarify the indications for allogeneic transplantation vis-à-vis autologous transplant and to discuss the rational and potential benefits of reduced intensity conditioning(RIC), non-myeloablative (NMA) transplant, T-cell depletion and variations in GVHD prophylaxis. Considerable effort has been spent in developing transplant regimens with reduced toxicity and reduced GVHD. The role of allogeneic transplantation has also been redefined in light of advances in lymphoma classification, diagnostic methods, particularly PET scan and advances in transplant technology. Haplo and UCB SCT allow identification of a donor for nearly all patients. RIC and NMA conditioning have reduced early toxicity but are associated with increased risk for disease recurrence. Promising data have been reported from a novel conditioning regimen combining NMAwith ibritumomab tiuxetan. T-cell depletion reduces cGVHD but has some increase in rate of recurrence. Rapamycin may be associated with reduction in risk for disease recurrence. In diffuse large B cell lymphoma, the outcome of allo SCT depends on patient characteristics and chemosensitivity. It is seful after failure of autoSCT and in partial responses to salvage therapy. Allo SCT may be the treatment of choice for advanced T-cell and NK cell lymphoma and for ATLL. Prophylactic or preemptive DLI may be useful, but requires controlled studies.