The impact of histologic grade on the outcome of high-dose therapy and autologous stem cell transplantation for follicular lymphoma
The impact of histologic grade on the outcome of high-dose therapy and autologous stem cell transplantation for follicular lymphoma
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DOI：
10.1038/sj.bmt.1705864
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发表时间：
2007-12-01
影响因子：
4.8
通讯作者：
Gopal, A. K.
中科院分区：
文献类型：
--
作者：
Pham, R. N.;Gooley, T. A.;Gopal, A. K.
滤泡性淋巴瘤(FL)的组织学分级对大剂量治疗(HDT)和自体干细胞移植(ASCT)结果的影响尚不清楚。我们评估了在我们中心接受HDT和ASCT的219名1-3级FL患者。在控制其他预测因素后，估计各分级的总生存期(OS)、无进展生存期(PFS)、复发和无复发死亡率(NRM)。FL 1级106例(48%)，2级75例(34%)，3级38例(17%)。整个队列的五年结果估计包括60%的OS，39%的PFS和46%的复发(中位数为7.8年)。在调整其他影响因素后，3级FL与1-2级FL患者的PFS和复发率基本相同(危险比分别为0.90，P=0.68；HR=1.07，P=0.80)。与疾病1-2级患者相比，3级FL患者的死亡率(HR=0.70，P=0.23)和NRM(HR=0.33，P=0.07)的风险无显著降低。与低度PFS相关的因素有乳酸脱氢酶升高(HR=1.5 2，P=0.0 3)、化疗耐受(HR=1.82，P=0.0 2)、既往2次治疗(HR=1.8，P=0.0 3)和既往放疗(HR=1.99，P=0.003)。这些数据表明FL的组织学分级不影响PFS，也不影响HDT和ASCT后复发。
The impact of the follicular lymphoma (FL) histologic grade on outcomes after high-dose therapy (HDT) and autologous stem cell transplantation (ASCT) is unknown. We evaluated 219 consecutive patients with grades 1-3 FL who underwent HDT and ASCT at our center. Overall survival ( OS), progression-free survival (PFS), relapse and non-relapse mortality (NRM) was estimated for each grade after controlling for other predictive factors. The number of patients with grades 1, 2 and 3 FL was 106 (48%), 75 (34%) and 38 (17%), respectively. Five-year outcome estimates for the entire cohort included 60% OS, 39% PFS and 46% relapse (median follow-up 7.8 years). PFS and relapse were nearly identical among patients with grade 3 FL versus grades 1-2 FL after adjusting for other contributing factors (hazard ratio (HR) = 0.90, P = 0.68; HR = 1.07, P = 0.80, respectively). The hazard for mortality (HR = 0.70, P = 0.23) and NRM (HR = 0.33, P = 0.07) was non- significantly lower among patients with grade 3 FL compared to patients with grades 1-2 disease. Factors associated with inferior PFS included elevated lactate dehydrogenase (HR = 1.52, P = 0.03), chemoresistance (HR = 1.82, P = 0.02), >= 2 prior therapies (HR = 1.8, P = 0.03) and prior radiation (HR = 1.99, P = 0.003). These data suggest that the histologic grade of FL does not impact PFS or relapse following HDT and ASCT.