Allogeneic stem cell transplantation in patients with Hodgkin's-Lymphoma.
Allogeneic stem cell transplantation in patients with Hodgkin's-Lymphoma.
复制标题
霍奇金淋巴瘤患者的同种异体干细胞移植。
DOI：
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发表时间：
2004
影响因子：
45.3
通讯作者：
Michael G. Kiehl
中科院分区：
文献类型：
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作者：
H. Pohl;A. Shimoni;N. Kroeger;Hans Martin;V. Vučinić;N. Basara;A. Nagler;A. Zander;A. Fauser;Michael G. Kiehl
背景：由于加强标准放化疗，相当大比例的霍奇金淋巴瘤患者将被治愈。对于标准治疗后复发的患者，选择的治疗方法是具有高缓解率的自体干细胞移植。尽管治疗取得了进展，但仍有一些患者患有难治性或复发性疾病。由于移植物抗霍奇金淋巴瘤的影响已经被描述清楚，异基因干细胞移植可能是这些高危患者的一种治疗方法。
方法
我们分析了自1999年7月至2003年11月期间接受同种异体移植的14名患者的病程。
结果
移植前患者平均年龄23岁(19-41岁)，平均接受4.5次化疗(2-8次)。除了一人之外，所有人之前都接受了自体移植。移植时疾病状态为CR 2例，PR 1例，SD 5例，PD 6例。8名患者接受了血缘关系相合的供者的移植，6名患者接受了非血缘供者的移植(4例匹配，2例DRB1不匹配)。除一人外，所有患者都接受了外周血干细胞移植。采用不同的预适应方案(氟达拉滨(Flu)/丁硫丹(Bu)“bATG n=6，Flu/Melphalan(MEL)”b CamPath n=5，Bu/Cyn=1，TbI/Cyn=1，MEL/Thiotepa/ATg n=1)。供者淋巴细胞输注4例，分别为SD(n=2)、PD(n=1)和混合嵌合体(n=1)。中位FU为25个月(1~52个月)，OS为43%，DFS为28.6%。TRM为14.3%。5名患者死于疾病进展，1名患者死于难治性移植物抗宿主病。
结论
考虑到所有患者都经过了严格的预治疗，而且只有两名患者在CR中被移植，这些数据证明了强大的移植物抗霍奇金效应。尤其是马法兰/氟达拉宾减量预适应在这种情况下似乎非常有效。此外，如果患者在疾病期间及早接受同种异体移植，异基因干细胞移植的结果可能会显著改善，这是推测的，但很有可能。因此，应该定义风险因素，并在受控的临床试验中安排那些具有高风险特征的患者进行同种异体移植。没有重大的财务关系需要披露。
6690 Background: Due to intensified standard radio-chemotherapy a substantial proportion of patients will be cured of Hodgkin's Lymphoma. In patients with relapse after standard therapy, the therapy of choice is an autologous stem cell transplantation with high remission rates. Despite therapeutic progress some patients suffer from refractory or relapsing disease. As graft versus Hodgkin's lymphoma effects have been described allready, allogeneic stem cell transplantation might be an therapeutic effort in these high risk patients.
METHODS
We analysed the course of 14 patients receiving an allogeneic transplant between 07/99 and 11/03.
RESULTS
Median age was 23 years (range 19 to 41) and patients received a median of 4.5 chemotherapies (range 2 to 8) before transplant. All but one received previously an autologous transplant. Disease status at transplant was CR in 2, PR in 1, SD in 5, and PD in 6 patients. Eight patients received a transplant from a related HLA-identical donor and 6 from an unrelated donor (4 matched, 2 DRB1 mismatch). All but one received peripheral blood stem cell grafts. Different conditioning regimens were used (Fludarabine (Flu)/busulfan (Bu) "b ATG n=6, Flu/Melphalan (Mel) "b Campath n=5, Bu/Cy n=1, TBI/Cy n=1, Mel/Thiotepa/ATG n=1). Four patients received donor lymphocyte infusions in escalating dosage for SD (n=2), PD (n=1), or mixed chimerism (n=1), respectively. OS is 43% and DFS 28.6% after a median FU of 25 months (1 to 52 months). TRM is 14.3 %. Five patients died due to disease progression and one due to refractory GVHD.
CONCLUSIONS
Taking into account that all patients were heavily pre-treated and that only two patients were transplanted in CR these data argue for a strong graft versus Hodgkin effect. Especially a melphalan/fludarabin "b ATG reduced conditioning seems to be very effective in this setting. Furthermore, it's speculative but very likely that the results of allogeneic stem cell transplantation will improve significantly if patients receive the allo transplant earlier during their disease. Thus, risk factors should be defined and those patients with a high risk feature should be scheduled for allo transplant within a controlled clinical trial. No significant financial relationships to disclose.