High-dose therapy and autologous stem-cell transplantation in angioimmunoblastic lymphoma: Complete remission at transplantation is the major determinant of outcome - Lymphoma working party of the European group for blood and marrow transplantation
High-dose therapy and autologous stem-cell transplantation in angioimmunoblastic lymphoma: Complete remission at transplantation is the major determinant of outcome - Lymphoma working party of the European group for blood and marrow transplantation
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DOI：
10.1200/jco.2007.12.6219
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发表时间：
2008-01-10
影响因子：
45.3
通讯作者：
Schmitz, Norbert
中科院分区：
文献类型：
--
作者：
Kyriakou, Charalampia;Canals, Carmen;Schmitz, Norbert
目的血管免疫母细胞T细胞淋巴瘤(AITL)患者目前常规化疗预后较差。本研究的目的是评价大剂量治疗(HDT)和自体干细胞移植(ASCT)对AITL患者的疗效。干细胞来源于143例患者的外周血。预适应方案不同，74%的患者接受卡莫司汀、1，3-二(2-氯乙基)-1-亚硝脲、依托泊苷、阿糖胞苷和马法兰化疗。结果中位随访31个月(3~174个月)，95例(65%)存活，51例(35%)死亡。42名患者死于疾病进展，9名患者死于与方案相关的毒性。12个月和24个月的累积无复发死亡率分别为5%和7%。24个月和48个月的精算总生存率分别为67%和59%。24个月和48个月的累积复发率估计分别为40%和51%。移植时的疾病状态是影响移植结果的主要因素。在首次完全缓解(CR)期间接受移植的患者在无进展存活率和OS方面有明显的优势。在CR中接受移植的患者在24个月和48个月时的PFS估计率分别为70%和56%；化疗敏感型患者在这两个时间点的PFS率分别为42%和30%；化疗难治性疾病患者的PFS率在这两个时间点均为23%。早期移植是达到最佳效果的必要条件。
PurposePatients with angioimmunoblastic T-cell lymphoma (AITL) have poor prognoses with current conventional chemotherapy. The aim of this study was to evaluate the effect of high-dose therapy (HDT) followed by autologous stem-cell transplantation (ASCT) on patients with AITL.Patients and MethodsWe report a retrospective, multicenter study of 146 patients with AITL who received ASCT. The source of the stem cells was peripheral blood in 143 patients. The conditioning regimen varied, and 74% of the patients received carmustine and 1,3-bis(2-chloroethyl)-1-nitrosourea; etoposide; ara-C; and melphalan chemotherapy.ResultsAfter a median follow-up of 31 months (range, 3 to 174 months), 95 patients (65%) remained alive, and 51 patients (35%) died. Forty-two patients died as a result of disease progression, and nine died as a result of regimen-related toxicity. The cumulative incidence of nonrelapse mortality was 5% and 7% at 12 and 24 months, respectively. The actuarial overall survival (OS) was 67% at 24 months and 59% at 48 months. The cumulative incidence of relapse was estimated at 40% and 51% at 24 and 48 months, respectively. Disease status at transplantation was the major factor that impacted outcome. Patients who received a transplant during first complete remission (CR) had significantly superior progression-free survival and OS. The estimated PFS rates for patients who received their transplants in CR were 70% and 56% at 24 and 48 months, respectively; 42% and 30% for patients with chemotherapy-sensitive disease at those time points, respectively; and 23% at both time points for patients with chemotherapy- refractory disease.ConclusionThis study shows that HDT and ASCT offers the possibility of long-term disease-free survival to patients with AITL. Early transplantation is necessary to achieve optimal results.