Comparison of reduced-intensity and conventional myeloablative regimens for allogeneic transplantation in non-Hodgkin's lymphoma
Comparison of reduced-intensity and conventional myeloablative regimens for allogeneic transplantation in non-Hodgkin's lymphoma
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DOI：
10.1016/j.bbmt.2006.08.035
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发表时间：
2006-12-01
影响因子：
4.3
通讯作者：
Forman, Stephen J.
中科院分区：
文献类型：
--
作者：
Rodriguez, Roberto;Nademanee, Auayporn;Forman, Stephen J.
在接受同种异体移植的非霍奇金淋巴瘤（NHL）患者中，使用降低强度方案（RIRs）的频率越来越高。减少剂量对复发和生存的影响尚未得到广泛研究。我们对88例接受常规清髓方案（CMRs） （n = 48）和氟达拉滨125 mg/m(2)和美法兰140 mg/m(2)的RIR （n = 40）的患者进行了回顾性分析。与接受CAIR的患者相比，接受RIR的患者年龄更大，自体移植失败的发生率更高，接受外周血和非亲属供体移植的发生率更高。预防移植物抗宿主病采用环孢素+甲氨蝶呤+/-强的松治疗CMR，环孢素+霉酚酸盐+/-甲氨蝶呤治疗RIR。CAIR组复发率明显低于RIR组（13% vs 28%; P = 0.05）。CMR患者1年移植相关死亡率为33%，RIR患者为28% （P = 0.40）。CMR的2年总生存率和无进展生存率分别为52%和46%，而RIR为53%和40% （P =无统计学意义）。利用基于竞争风险、单变量分析和治疗相关预后因素的累积发生率函数，我们发现较高的治疗强度（P = 0.03；相对风险[RR] = 35%）和既往没有自体移植（P = 0.0007; RR = 20%）与较低的复发率相关。使用Cox多变量比例风险模型，我们发现移植时的化疗敏感性疾病（P = 0.05; RR = 57%）和既往没有自体移植（P = 0.002; RR = 37%）与生存率的提高相关。我们在接受CMR和接受RIR的患者中观察到相似的生存率，证实了RIR是高危NHL患者可行的替代方案；然而，数据显示治疗强度降低和既往自体移植与复发增加有关。(C) 2006年美国血液和骨髓移植学会。
Reduced-intensity regimens (RIRs) are being used with increasing frequency in patients with non-Hodgkin's lymphoma (NHL) undergoing allogeneic transplantation. The impact of dose reduction on relapse and survival has not been extensively studied. We performed a retrospective analysis of 88 patients conditioned with conventional myeloablative regimens (CMRs) (n = 48) and an RIR (n = 40) of fludarabine 125 mg/m(2) and melphalan 140 mg/m(2). Compared with the patients receiving CAIR, those receiving RIR were older, had more often failed autologous transplantation, and had more frequently received peripheral blood and unrelated donor transplants. Graft-versus-host disease prophylaxis was provided with cyclosporine + methotrexate +/- prednisone for the CMR and with cyclosporine + mycophenolate +/- methotrexate for the RIR. The relapse rate was significantly lower in the patients receiving CAIR than in those receiving RIR (13% vs 28%; P =.05). The 1-year transplantation-related mortality rate was 33% for CMR and 28% for RIR (P =.40). Kaplan-Meier 2-year overall survival and progression-free survival were 52% and 46% for CMR versus 53% and 40% for RIR (P = not significant). Using cumulative incidence functions based on competing risks, univariate analysis, and treatment-related prognostic factors, we found that higher treatment intensity (P =.03; relative risk [RR] = 35%) and absence of previous autologous transplantation (P =.0007; RR = 20%) were associated with a lower relapse rate. Using a Cox urtivariate proportional hazards model, we found that chemosensitive disease at transplantation (P =.05; RR = 57%) and absence of previous autologous transplantation (P =.002; RR = 37%) were associated with improved survival. Our observation of similar survival in the patients receiving CMR and those receiving RIR confirms that RIRs are feasible alternatives for high-risk patients with NHL; however, the data suggest that reduced treatment intensity and previous autologous transplantation are associated with increased relapse. (C) 2006 American Society for Blood and Marrow Transplantation.