Outcomes of Patients with Recurrent and Refractory Lymphoma Undergoing Allogeneic Hematopoietic Cell Transplantation with BEAM Conditioning and Sirolimus- and Tacrolimus-Based GVHD Prophylaxis.
Outcomes of Patients with Recurrent and Refractory Lymphoma Undergoing Allogeneic Hematopoietic Cell Transplantation with BEAM Conditioning and Sirolimus- and Tacrolimus-Based GVHD Prophylaxis.
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复发性难治性淋巴瘤患者接受同种异体造血细胞移植、BEAM 调理以及基于西罗莫司和他克莫司的 GVHD 预防的结果。
DOI：
10.1016/j.bbmt.2018.09.009
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Nakamura,Ryotaro
中科院分区：
文献类型：
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作者：
Salhotra,Amandeep;Mei,Matthew;Stiller,Tracey;Mokhtari,Sally;Herrera,AlexF;Chen,Robert;Popplewell,Leslie;Zain,Jasmine;Ali,Haris;Sandhu,Karamjeet;Budde,Elizabeth;Nademanee,Auayporn;Forman,StephenJ;Nakamura,Ryotaro
目前对霍奇金淋巴瘤(HL)和非霍奇金淋巴瘤(NHL)患者的标准护理是大剂量的预适应，然后是自体干细胞移植(ASCT)。对于一些患者(即高风险患者、动员后干细胞数量不足或骨髓受累的患者)，异基因造血细胞移植(AllHCT)提供了治愈的潜力。然而，大多数接受同种异体红细胞移植的患者接受低强度预适应作为准备方案，评估异基因同种异体细胞移植患者清髓预适应效果的研究有限。在这项回顾性研究中，我们回顾了2005年至2018年在希望之城接受同种异体骨髓移植加清髓BEAM调节并接受他克莫司/西罗莫司作为移植物抗宿主病(GVHD)预防措施的22例复发和难治性NHL患者的结果。中位随访期2.6年(1.0~11.2年)，2年总生存率和无事件生存率分别为58.3%(95%可信区间，35.0%~75.8%)和45.5%(95%可信区间，24.4%~64.3%)。II~IV级急性移植物抗宿主病的累积发生率为45.5%(95%CI，23.8%~64.9%)，仅1例发生IV级急性移植物抗宿主病。然而，55%的患者(n = 12)出现慢性移植物抗宿主病。在22名符合条件的患者中，2名曾接受过ASCT，2名曾接受过异基因HCT。两名既往接受ASCT的患者均出现严重的方案相关毒性反应。化疗难治性疾病患者接受异基因HCT的生存率较低，1年OS和EFS分别为44.4%和33.0%。综上所述，对于ASCT后预后较差的高危淋巴瘤患者，应考虑采用BEAM准备方案的allHCT和基于他克莫司/西罗莫司的GVHD。
The current standard of care for patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is high-dose conditioning followed by autologous stem cell transplantation (ASCT). For some patients (ie, those with highest-risk disease, insufficient stem cell numbers after mobilization, or bone marrow involvement) allogeneic hematopoietic cell transplantation (alloHCT) offers the potential for cure. However, the majority of patients undergoing alloHCT receive reduced-intensity conditioning as a preparative regimen, and studies assessing outcomes of patients after alloHCT with myeloablative conditioning are limited. In this retrospective study, we reviewed outcomes of 22 patients with recurrent and refractory NHL who underwent alloHCT with myeloablative BEAM conditioning and received tacrolimus/sirolimus as graft-versus-host disease (GVHD) prophylaxis at City of Hope between 2005 and 2018. With a median follow-up of 2.6 years (range, 1.0 to 11.2 years), the probabilities of 2-year overall survival and event-free survival were 58.3% (95% confidence interval [CI], 35.0% to 75.8%) and 45.5% (95% CI, 24.4% to 64.3%), respectively. The cumulative incidence of grade II to IV acute GVHD was 45.5% (95% CI, 23.8% to 64.9%), with only 1 patient developing grade IV acute GVHD. However, chronic GVHD was seen in 55% of the patients (n = 12). Of the 22 eligible patients, 2 had undergone previous ASCT and 2 had undergone previous alloHCT. Both patients with previous ASCT developed severe regimen-related toxicity. Patients who underwent alloHCT with chemorefractory disease had lower survival rates, with 1-year OS and EFS of 44.4% and 33.0%, respectively. In conclusion, alloHCT with a BEAM preparative regimen and tacrolimus/sirolimus-based GVHD should be considered as an alternative option for patients with highest-risk lymphoma whose outcomes are expectedly poor after ASCT.