Rituximab reduces relapse risk after allogeneic and autologous stem cell transplantation in patients with high‐risk aggressive non‐Hodgkin's lymphoma
Rituximab reduces relapse risk after allogeneic and autologous stem cell transplantation in patients with high‐risk aggressive non‐Hodgkin's lymphoma
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利妥昔单抗可降低高危侵袭性非霍奇金淋巴瘤患者同种异体和自体干细胞移植后的复发风险
DOI：
10.1046/j.1365-2141.2003.04446.x
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发表时间：
2003
影响因子：
6.5
通讯作者：
A. Nagler
中科院分区：
文献类型：
--
作者：
A. Shimoni;I. Hardan;A. Avigdor;M. Yeshurun;P. Raanani;I. Ben;A. Nagler
摘要高剂量化疗和自体干细胞移植（SCT）在难治性侵袭性淋巴瘤患者中的成功率有限。在这种情况下，同种异体SCT可能通过提供移植物抗淋巴瘤效应提供一些优势，但复发风险仍然很大。在这项研究中，我们评估了SCT后利妥昔单抗给药在移植后复发高危患者中的安全性和有效性，以降低复发风险。纳入了28例患者，目的是在自体（n = 16）或同种异体（n = 12）SCT后接受利妥昔单抗治疗。 24例患者从SCT后中位数47天开始接受利妥昔单抗治疗。 3例在治疗前死于SCT并发症。9例SCT后未达到完全缓解（CR）的患者使用利妥昔单抗转为CR，3例发生移植物抗宿主病（GVHD）。中位随访时间为12个月（范围：3-33个月），估计的2年总生存率和无病生存率分别为85 ± 7%和55 ± 13%。 当仅分析实际接受治疗的患者时，这些比率分别为95 ± 7%和64 ± 13%。 复发风险为35 ± 14%。 7例患者发生了与重度低丙种球蛋白血症相关的复发性中性粒细胞减少症发作，并通过静脉注射免疫球蛋白进一步预防。10例接受利妥昔单抗治疗的异基因SCT受者均未发生严重GVHD。利妥昔单抗可能是SCT后有效的辅助治疗，以降低复发率并改善高危侵袭性淋巴瘤的结局。更大规模的比较试验是必要的，以更好地确定其在SCT中的作用。
Summary. High‐dose chemotherapy and autologous stem cell transplantation (SCT) have limited success in patients with refractory aggressive lymphoma. Allogeneic SCT may offer some advantage in this setting by providing graft‐versus‐lymphoma effect, but the relapse risk remains substantial. In this study, we evaluated the safety and efficacy of rituximab administration after SCT in patients at high‐risk for post‐transplant relapse, in order to reduce relapse risk. Twenty‐eight patients were included with the intent to treat them with rituximab after autologous (n = 16) or allogeneic (n = 12) SCT. Twenty‐four were given rituximab starting a median of 47 d post SCT. Three died of SCT complications prior to therapy. Nine patients not achieving a complete remission (CR) post SCT converted to CR with rituximab and with the onset of graft‐versus‐host disease (GVHD) in three. With a median follow‐up of 12 months (range, 3–33 months) the estimated 2‐year overall survival and disease‐free survival was 85 ± 7% and 55 ± 13% respectively. When only those patients who were actually treated are analysed, these rates were 95 ± 7% and 64 ± 13% respectively. The relapse risk was 35 ± 14%. Seven patients had recurrent neutropenia episodes associated with severe hypogammaglobulinaemia, which were further prevented with intravenous immunoglobulin. None of the 10 allogeneic SCT recipients treated with rituximab had severe GVHD. Rituximab may be an effective adjuvant therapy after SCT to reduce the relapse rate and improve the outcome in high‐risk aggressive lymphoma. Larger scale comparative trials are necessary to better define its role in SCT.
与同种异体骨髓移植相关的移植物抗淋巴瘤效应的证据。
影响因子：
20.3
作者：
Jones,RJ;Ambinder,RF;Piantadosi,S;Santos,GW
通讯作者：
Santos,GW