Correlation of pretransplant and early post-transplant response assessment with outcomes after reduced-intensity allogeneic hematopoietic stem cell transplantation for non-Hodgkin's lymphoma.
Correlation of pretransplant and early post-transplant response assessment with outcomes after reduced-intensity allogeneic hematopoietic stem cell transplantation for non-Hodgkin's lymphoma.
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DOI：
10.1002/cncr.24845
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发表时间：
2010-02-15
期刊：
影响因子：
6.2
通讯作者：
Fowler DH
中科院分区：
文献类型：
--
作者：
Bishop MR;Dean RM;Steinberg SM;Odom J;Pollack SM;Pavletic SZ;Sportes C;Gress RE;Fowler DH
化疗敏感性，简单地定义为至少部分响应化疗，是一个重要的结果预测非霍奇金淋巴瘤（NHL）患者接受降低强度异基因造血干细胞移植（allo-HCT）。作者假设，通过特异性反应，完全缓解（CR）与部分缓解（PR）与稳定疾病（SD）与疾病进展（PD）进一步区分化疗敏感性与移植后结局相关。在63例接受低强度allo-HCT治疗的NHL患者中分析了移植前和移植后早期（28天）疾病反应对移植结局的影响。所有患者的3年无事件生存率（EFS）和总生存率（OS）（降低强度allo-HCT后的中位潜在随访时间= 58个月）分别为37%和47%。基于移植前缓解的3年EFS为：CR = 50%; PR = 66%; SD = 18%;无移植前PD患者达到3年随访。基于移植前反应的3年OS为：CR = 63%; PR = 69%; SD = 45%。基于移植后缓解的3年EFS为：CR = 57%; PR = 32%; SD = 33%;无移植后PD患者达到3年随访。基于移植后反应的3年OS为：CR = 65%; PR = 43%; SD = 50%。在多变量分析中，移植前反应是EFS的最佳预测因素（P < .0001）。移植前反应（P <0.0001）和年龄（P = 0.0035）与OS共同相关。这些数据表明，NHL患者移植前SD，通常被认为是不合适的候选人，可能会受益于降低强度的allo-HCT，移植前PD患者应仅在临床试验中接受这种治疗。
Chemotherapy sensitivity, defined simply as at least a partial response to chemotherapy, is an important outcome predictor for non-Hodgkin lymphoma (NHL) patients undergoing reduced-intensity allogeneic hematopoietic stem cell transplantation (allo-HCT). The authors hypothesized that further differentiation of chemotherapy sensitivity by specific response, complete remission (CR) versus partial remission (PR) versus stable disease (SD) versus progression of disease (PD), correlates with post-transplant outcomes. The impact of pretransplant and early (28 days) post-transplant disease response on transplant outcomes was analyzed in 63 NHL patients treated with reduced-intensity allo-HCT. The 3-year event-free survival (EFS) and overall survival (OS) (median potential follow-up after reduced-intensity allo-HCT = 58 months) for all patients was 37% and 47%, respectively. The 3-year EFS based on pretransplant response was: CR = 50%; PR = 66%; SD = 18%; no patient with PD pretransplant reached 3-year follow-up. The 3-year OS based on pretransplant response was: CR = 63%; PR = 69%; SD = 45%. The 3-year EFS based on post-transplant response was: CR = 57%; PR = 32%; SD = 33%; no patient with PD post-transplant reached 3-year follow-up. The 3-year OS based on post-transplant response was: CR = 65%; PR = 43%; SD = 50%. In multivariate analyses, pretransplant response was the best predictor of EFS (P < .0001). Pretrans-plant response (P < .0001) and age (P = .0035) were jointly associated with OS. These data suggest that NHL patients with pretransplant SD, generally considered inappropriate candidates, may benefit from reduced-intensity allo-HCT, and patients with pretransplant PD should only receive this therapy in clinical trials.
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