Allogeneic stem cell transplantation for patients with relapsed chemorefractory aggressive non-hodgkin lymphomas.
Allogeneic stem cell transplantation for patients with relapsed chemorefractory aggressive non-hodgkin lymphomas.
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DOI：
10.1016/j.bbmt.2009.01.010
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Devine SM
中科院分区：
文献类型：
--
作者：
Hamadani M;Benson DM Jr;Hofmeister CC;Elder P;Blum W;Porcu P;Garzon R;Blum KA;Lin TS;Marcucci G;Devine SM
化疗耐药的侵袭性非霍奇金淋巴瘤(NHL)患者在现有治疗方法下临床疗效一般较差。同种异体移植可能是治愈的，但在这种情况下指导移植决策的研究很少。我们研究了46例化疗耐药、侵袭性NHL患者的异基因移植结果，这些患者分别有稳定期(SD，n=32)和进展期(PD，n=14)患者，在最后一次抢救治疗后。中位年龄46岁(22-63岁)。39例接受了匹配的同胞同种异体移植，7例接受了无血缘关系的供者移植。其中弥漫性大B细胞淋巴瘤18例，Burkitt淋巴瘤3例，转化性B细胞淋巴瘤5例，套细胞淋巴瘤11例，外周T细胞淋巴瘤9例。既往治疗的中位数为3次(范围2-8次)。存活患者的中位随访期为5年。全组(n=46)5年总生存率(OS)、无进展生存率(PFS)和复发率分别为38%、34%和35%。II-IV级急性移植物抗宿主病(GVHD)发生率为43%。在33名可评估的患者中，75%发展为慢性移植物抗宿主病。总的无复发死亡率为34%。SD和PD患者的5年OS率和PFS率分别为46%和21%(p值=0.0002；对数等级检验)和46%和7%(p值=0.0002；对数等级检验)。这项研究证实了同种异体移植对化疗耐药的SD患者是有效的。然而，帕金森病患者在使用传统的条件反射方法进行同种异体移植后，结果一致较差。考虑到在帕金森病的治疗环境中可以看到的结果，这类患者应该只在研究治疗的环境中进行移植。
Patients with chemorefractory aggressive non-Hodgkin’s lymphomas (NHL) generally have poor clinical outcomes with available therapies. Allogeneic transplantation may be curative, but few studies are available to guide transplant decision making in this setting. We examined allogeneic transplantation outcomes for 46 patients with chemorefractory, aggressive NHL patients who had either stable disease (SD, n=32) or progressive disease (PD, n=14), respectively, following last salvage treatment. The median age was 46 years (range 22–63 yrs). 39 patients received matched sibling allografts, while 7 underwent unrelated donor transplantation. Diagnoses included diffuse large B-cell lymphoma (n=18), Burkitt’s lymphoma (n=3), transformed B-cell lymphoma (n=5), mantle cell lymphoma (n=11) and peripheral T-cell lymphoma (n=9). The median number of prior therapies was 3 (range 2–8). Median follow-up of surviving patients is 5-years. 5-year overall survival (OS), progression free survival (PFS), and relapse rate for the whole cohort (n=46) were 38%, 34%, and 35% respectively. The rate of grade II–IV acute graft-versus-host disease (GVHD) was 43%. Of the 33 evaluable patients 75% developed chronic GVHD. Overall non-relapse mortality rate was 34%. The 5-year OS and PFS rates for patients with SD and PD were 46% vs. 21% (p-value=0.01; log-rank test), and 46% vs. 7% (p-value=0.0002; log-rank test) respectively. This study confirms that allogeneic transplant is curative for a subset of chemorefractory patients with SD. However, patients with PD had uniformly poor outcomes following allografting with conventional conditioning approaches. Given the outcomes seen here in the setting of PD, such patients should proceed with transplant only in the setting of investigational therapy.
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影响因子：
4.3
作者：
Chen, Andy I.;McMillan, Alex;Neprin, Robert S.;Horning, Sandra J.;Laport, Ginna G.
通讯作者：
Laport, Ginna G.
影响因子：
20.3
作者：
Robinson, SP;Goldstone, AH;Schmitz, N
通讯作者：
Schmitz, N
影响因子：
11.4
作者：
Corradini, P.;Dodero, A.;Tarella, C.
通讯作者：
Tarella, C.
影响因子：
4.8
作者：
Juckett, M;Rowlings, P;Vesole, D
通讯作者：
Vesole, D
影响因子：
45.3
作者：
Harris, NL;Jaffe, ES;Bloomfield, CD
通讯作者：
Bloomfield, CD