Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas: long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect
Allogeneic transplantation following a reduced-intensity conditioning regimen in relapsed/refractory peripheral T-cell lymphomas: long-term remissions and response to donor lymphocyte infusions support the role of a graft-versus-lymphoma effect
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DOI：
10.1038/leu.2011.240
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发表时间：
2012-03-01
期刊：
影响因子：
11.4
通讯作者：
Corradini, P.
中科院分区：
文献类型：
--
作者：
Dodero, A.;Spina, F.;Corradini, P.
挽救性化疗或自体干细胞移植 (autoSCT) 对于复发性外周 T 细胞淋巴瘤 (PTCL) 的治疗效果令人失望。我们回顾性评估了 52 名接受同种异体 SCT 治疗复发性疾病的患者的长期结果。组织学为 PTCL（未另行指定）（n = 23）、间变性大细胞淋巴瘤（n = 11）、血管免疫母细胞 T 细胞淋巴瘤（n = 9）和罕见亚型（n = 9）。患者从相关兄弟姐妹 (n = 33, 64%) 或替代供体 (n = 13 (25%) 来自非亲属供体和 6 (11%) 来自单倍体家族供体) 进行同种异体移植，遵循包括塞替派、氟达拉滨和环磷酰胺在内的降低强度调节 (RIC) 方案。大多数患者患有化疗敏感性疾病（n = 39，75%），其中 27 名患者（52%）之前的 autoSCT 失败。中位随访时间为 67 个月，52 名患者中有 27 名存活 (52%)，25 名 (48%) 死亡（n = 19 名疾病进展，n = 6 名非复发死亡率 (NRM)）。 NRM 的 5 年累积发生率 (CI) 为 12%。广泛的慢性移植物抗宿主病增加了 NRM 的风险（33% vs 8%，P = 0.04）。 5 年时复发的 CI 为 49%，受同种异体移植时疾病状态 (P = 0.0009) 和治疗线 (P = 0.007) 的影响。五年总生存率和无进展生存率 (PFS) 分别为 50% (95% CI, 36 -63%) 和 40% (95% CI, 27 - 53%)。目前的 PFS 为 44%（95% CI，30-57%）。总的来说，12 名因疾病进展而接受供体淋巴细胞输注的患者中有 8 名（66%）出现了缓解。多变量分析显示，难治性疾病和年龄超过 45 岁是独立的不良预后因素。 RIC同种异体SCT是一种有效的挽救治疗方法，对于患有化疗敏感疾病的年轻患者来说具有更好的结果。白血病 (2012) 26, 520-526; doi：10.1038/leu.2011.240； 2011 年 9 月 9 日在线发布
Rescue chemotherapy or autologous stem cell transplantation (autoSCT) gives disappointing results in relapsed peripheral T-cell lymphomas (PTCLs). We have retrospectively evaluated the long-term outcome of 52 patients receiving allogeneic SCT for relapsed disease. Histologies were PTCL-not-otherwise specified (n = 23), anaplastic large-cell lymphoma (n = 11), angio-immunoblastic T-cell lymphomas (n = 9) and rare subtypes (n = 9). Patients were allografted from related siblings (n = 33, 64%) or alternative donors (n = 13 (25%) from unrelated and 6 (11%) from haploidentical family donors), following reduced-intensity conditioning (RIC) regimens including thiotepa, fludarabine and cyclophosphamide. Most of the patients had chemosensitive disease (n = 39, 75%) and 27 (52%) failed a previous autoSCT. At a median follow-up of 67 months, 27 of 52 patients were found to be alive (52%) and 25 (48%) were dead (n = 19 disease progression, n = 6 non-relapse mortality (NRM)). The cumulative incidence (CI) of NRM was 12% at 5 years. Extensive chronic graft-versus-host disease increased the risk of NRM (33% versus 8%, P = 0.04). The CI of relapse was 49% at 5 years, influenced by disease status at the time of allografting (P = 0.0009) and treatment lines (P = 0.007). Five-year overall survival and progression-free survival (PFS) were 50% (95% CI, 36 -63%) and 40% (95% CI, 27 - 53%), respectively. The current PFS was 44% (95% CI, 30-57%). In all, 8 out of 12 patients (66%) who received donor-lymphocytes infusions for disease progression had a response. At multivariable analysis, refractory disease and age over 45 years were independent adverse prognostic factors. RIC allogeneic SCT is an effective salvage treatment with a better outcome for younger patients with chemosensitive disease. Leukemia (2012) 26, 520-526; doi:10.1038/leu.2011.240; published online 9 September 2011