A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma
A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma
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DOI：
10.1182/blood-2002-05-1483
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发表时间：
2003-04-01
期刊：
影响因子：
20.3
通讯作者：
Horowitz, MM
中科院分区：
文献类型：
--
作者：
Levine, JE;Harris, RE;Horowitz, MM
淋巴母细胞淋巴瘤（LBL）是一种罕见的、临床侵袭性的年轻人肿瘤，常累及骨髓和/或中枢神经系统。由于LBL与急性淋巴细胞白血病相似，一些研究中心更倾向于异体造血干细胞移植而不是自体造血干细胞移植。我们回顾性分析了1989年至1998年间接受自体（自体，n = 128）或hla -同卵同胞（同种异体，n = 76） SC移植并向国际骨髓移植登记处（IBMTR）或自体血液和骨髓移植登记处（ABMTR）报告的患者的结果。同种异体干细胞移植（SCT）接受者在6个月时具有更高的治疗相关死亡率（TRM）（118%对3%，P = 0.002），并且这种劣势在1年和5年持续存在。同种异体干细胞移植和自体干细胞移植后的早期复发率相似，但同种异体干细胞移植接受者在1年和5年的复发率明显较低（32%对46%，P = 0.05； 34%对56%，P = 0.004）。同种异体干细胞移植和自体干细胞移植的无淋巴瘤生存率无差异（5年生存率分别为36%和39%，P = 0.82）。AutoSCT接受者在6个月时的总生存率更高（75%对59%，P = 0.01），但两组在1年和5年的生存率无显著差异（60%对49%，P = 0.09； 44%对39%，P = 0.47）。考虑混杂因素的多变量分析证实了这些结果。与SCT类型无关，移植时BM受累和疾病状态比首次完全缓解更晚期与预后较差相关。总之，同种异体干细胞移植治疗LBL的复发率低于自体干细胞移植，但较高的TRM抵消了任何潜在的生存益处。
Lymphoblastic lymphoma (LBL) is a rare, clinically aggressive neoplasm of the young that frequently involves the bone marrow (BM) and/or central nervous system. Because LBL is similar to acute lymphoblastic leukemia, some centers prefer allogeneic hematopoietic stem cell (SC) transplantation to autologous SC transplantation. We retrospectively analyzed outcomes for patients who underwent autologous (auto, n = 128) or HLA-identical sibling (allo, n = 76) SC transplantations from 1989 to 1998 and were reported to International Bone Marrow Transplant Registry (IBMTR) or Autologous Blood and Marrow Transplant Registry (ABMTR). Allo stem cell transplant (SCT) recipients had higher treatment-related mortality (TRM) at 6 months (118% versus 3%, P = .002), and this disadvantage persisted at 1 and 5 years. Early relapse rates after alloSC transplantation and autoSC transplantation were similar, but significantly lower relapse rates were observed in alloSCT recipients at 1 and 5 years (32% versus 46%, P = .05; and 34% versus 56%, P = .004, respectively). No differences were noted in lymphoma-free survival rates between alloSC transplantations and autoSC transplantations (5-year rates 36% versus 39%, P = .82). AutoSCT recipients had higher overall survival at 6 months (75% versus 59%, P = .01), but survival did not significantly differ between the 2 groups at 1 and 5 years (60% versus 49%, P = .09; 44% versus 39%, P = .47, respectively). Multivariate analyses to account for confounding factors confirmed these results. Independent of SCT type, BM involvement at the time of transplantation and disease status more advanced than first complete remission were associated with inferior outcomes. In summary, alloSC transplantation for LBL is associated with fewer relapses than with autoSC transplantation, but higher TRM off sets any potential survival benefit.