The international prognostic index assessed at relapse predicts outcomes of autologous transplantation for diffuse large-cell non-Hodgkin's lymphoma in second complete or partial remission
The international prognostic index assessed at relapse predicts outcomes of autologous transplantation for diffuse large-cell non-Hodgkin's lymphoma in second complete or partial remission
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DOI：
10.1016/j.bbmt.2006.12.452
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发表时间：
2007-04-01
影响因子：
4.3
通讯作者：
Burns, Linda J.
中科院分区：
文献类型：
--
作者：
Lerner, Rachel E.;Thomas, William;Burns, Linda J.
自体造血干细胞移植（autoHSCT）已成为常规挽救化疗后复发的弥漫性大细胞非霍奇金淋巴瘤（NHL）患者的标准治疗方法。然而，这些患者中有一半以上会在自体HSCT后复发并死亡。本研究旨在确定复发时评估的国际预后指数（IPI）（IPI-R）是否可用于识别自体HSCT后长期生存概率更高的患者。80例弥漫性大细胞淋巴瘤患者，中位年龄47岁（范围19-68岁），第二次完全缓解（CR 2，n = 27）或部分缓解（PR 2，n = 53），在1984年至2002年期间接受自体HSCT治疗。分析预测总生存期（OS）和无进展生存期（PFS）的临床特征。自体HSCT后，73例患者（91%）实现CR。中位随访时间为5年（范围1.0-14.2年），5年时的OS和PFS分别为38%（95%置信区间[CI] 27%-50%）和32%（95% CI 22%-42%）。通过IPI-R确定了OS和PFS显著不同的两个风险组。高风险组（3、4或5个IPI因素）的死亡风险是低风险组（0、1或2个IPI因素）的2.0倍（95% CI 1.1-4.0，P =.03），复发风险是低风险组的2.2倍（95% CI 1.2-4.0，P =.01）。高风险和低风险IPI-R组的中位OS分别为5个月和27个月，中位PFS分别为2个月和8个月。在考克斯回归分析中，高危IPI-R状态（相对风险[RR] 2.4，95% CI 1.2-4.8，P = 0.02）和诊断时骨髓（BM）受累（RR 2.9，95% CI 1.3-6.4，P = 0.01）是OS不良的独立预测因子。（RR 2.5，95% CI 1.3-4.7，P = 0.01）和诊断时BM受累（RR 3.9，95% CI 1.7-8.7，P = 0.001）是PFS差的独立预测因素。这些结果表明，IPI-R可预测CR 2或PR 2的侵袭性NHL患者自体HSCT后的OS和PFS。高风险IPI-R患者应考虑采用新的治疗方法。(c)2007年美国血液和骨髓移植学会。
Autologous hematopoietic stem cell transplantation (auto HSCT) has become the standard treatment for patients with relapsed diffuse large-cell non-Hodgkin's lymphoma (NHL) responding to conventional salvage chemotherapy. Nevertheless, more than half of these patients will relapse following auto HSCT and die. This study was undertaken to determine whether the International Prognostic Index (IPI) assessed at time of relapse (IPI-R) could be used to identify patients with greater probability for long-term survival following auto HSCT. Eighty patients, median age 47 years (range 19-68 years), with diffuse large cell lymphoma in either second complete remission (CR 2, n = 27) or partial remission (PR 2, n = 53) were treated between 1984 and 2002 with auto HSCT. Clinical features predictive of overall survival (OS) and progression-free survival (PFS) were analyzed. Post-auto HSCT, CR was achieved in 73 patients (91%). With a median follow-up of 5 years (range 1.0-14.2 years), OS and PFS at 5 years were 38% (95% confidence interval [CI] 27%-50%) and 32% (95% Cl 22%-42%), respectively. Two risk groups with significantly different OS and PFS were identified by the IPI-R. The high-risk group (3, 4, or 5 IPI factors) had 2.0 times (95% CI 1.1-4.0, P =.03) the risk of death and 2.2 times (95% CI 1.2-4.0, P =.01) the risk of relapse as the low-risk group (0, 1, or 2 IPI factors). The median OS was 5 months versus 27 months and the median PFS was 2 months versus 8 months for the high- and low-risk IPI-R groups, respectively. In Cox regression analysis, high-risk IPI-R status (relative risk [RR] 2.4, 95% CI 1.2-4.8, P =.02) and bone marrow (BM) involvement at diagnosis (RR 2.9, 95% Cl 1.3-6.4, P =.01) were independent predictors for poor OS. Similarly, high-risk IPI-R status (RR 2.5, 95% CI 1.3-4.7, P =.01) and BM involvement at diagnosis (RR 3.9,95% Cl 1.7-8.7, P =.001) were independent predictors for poor PFS. These results suggest that the IPI-R predicts OS and PFS following auto HSCT for patients with aggressive NHL in CR 2 or PR 2. Patients with high-risk IPI-R should be considered for novel therapeutic approaches. (c) 2007 American Society for Blood and Marrow Transplantation.