T cell-depleted allogeneic bone marrow transplantation for high-risk non-Hodgkin's lymphoma: clinical and molecular follow-up
T cell-depleted allogeneic bone marrow transplantation for high-risk non-Hodgkin's lymphoma: clinical and molecular follow-up
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DOI：
10.1038/sj.bmt.1701209
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发表时间：
1998-05-01
影响因子：
4.8
通讯作者：
Vesole, D
中科院分区：
文献类型：
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作者：
Juckett, M;Rowlings, P;Vesole, D
在复发性非霍奇金淋巴瘤（NHL）患者中使用同种异体BMT提供了无肿瘤骨髓的优势，并可能具有“移植物抗淋巴瘤效应”，这可能会降低复发的风险。然而，同种异体BMT也会增加因移植物抗宿主病（GVHD）而导致的死亡风险，这可以通过T细胞耗竭来改善。我们对1988年至1996年间37例接受去T细胞同种异体骨髓移植治疗侵袭性和惰性NHL的患者进行了回顾性分析。聚合酶链反应（PCR）被用来确定惰性NHL患者的BCL 2/IgH易位，作为残留疾病的标志物。37例患者中有16例（44%）存活且无进展，中位随访时间为4.4年（范围1-10.3年）。2-4级急性GVHD发生率为36%，广泛慢性GVHD发生率为12%。侵袭性NHL患者的总体PFS为33%（12-54%）;化疗耐药和敏感性疾病患者的5年PFS分别为17%（0-47%）和40%（15-65%）。组织学惰性患者的总体PFS为62%（37-86%）;化疗耐药和敏感疾病患者的5年PFS分别为55%（25-85%）和80%（45-100%）。八名无痛性疾病患者通过PCR检测到BCL 2/IgH易位。这8例患者中有5例在BMT后中位6.5年（范围2.1-7.4年）仍存活且无进展，其中4例在移植后1.7 - 2.9年仍保持PCR阳性。我们的结论是，T细胞耗尽的同种异体骨髓移植造成的死亡风险较低，由于G-VHD，应考虑复发性和难治性惰性NHL患者。
The use of allogeneic BMT in patients with relapsed non-Hodgkin lymphoma (NHL) offers the advantage of tumor-free bone marrow and possibly a 'graft-versus-lymphoma effect' which may decrease the risk of recurrence. However, allogeneic BMT also poses an increased risk of death due to graft-versus-host disease (GVHD) which can be ameliorated by T cell depletion. We performed a retrospective review of 37 patients who underwent T cell-depleted allogeneic BMT for aggressive and indolent NHL between 1988 and 1996. Polymerase chain reaction (PCR) was used to identify indolent NHL patients with the BCL2/IgH translocation which served as a marker of residual disease. Sixteen of 37 patients (44%) are alive and progression-free with a median follow-up of 4.4 years (range 1-10.3). The incidence of grade 2-4 acute GVHD was 36% and extensive chronic GVHD developed in 12%. Patients with aggressive NHL have an overall PFS of 33% (12-54%); those with chemotherapy-resistant and sensitive disease have PFS of 17% (0-47%), and 40% (15-65%) respectively at 5 years. Patients with indolent histologies have overall PFS of 62% (37-86%); those with chemotherapy-resistant and sensitive disease have PFS of 55% (25-85%) and 80% (45-100%) respectively at 5 years. Eight patients with indolent disease had a BCL2/IgH translocation detectable by PCR. Five of these eight patients remain alive and progression free at a median of 6.5 years after BMT (range 2.1-7.4 years), four of whom remain PCR positive from 1.7 to 2.9 years after transplantation. We conclude that T cell-depleted allogeneic BMT poses a low risk for death due to G-VHD, and should be considered for patients with relapsed and refractory indolent NHL.