Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome
Reduced intensity conditioning allogeneic stem cell transplantation for Hodgkin's lymphoma: identification of prognostic factors predicting outcome
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DOI：
10.3324/haematol.13441
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发表时间：
2009-02-01
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影响因子：
--
通讯作者：
Schmitz, Norbert
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文献类型：
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作者：
Robinson, Stephen P.;Sureda, Anna;Schmitz, Norbert
BackgroundThe的作用，降低强度的条件异基因造血干细胞移植（RICalloSCT）在霍奇金淋巴瘤患者的管理仍然存在争议。设计和MethodsTo进一步定义其作用，我们进行了回顾性分析，285例HL谁接受了RICalloSCT，以确定预后因素，预测结果。百分之八十的患者进行了自体干细胞移植前和25%的难治性疾病在transplant. ResultsNon-recurrence死亡率与化疗难治性疾病，性能状态差，年龄>45和2002年之前移植。对于无风险因素的患者，3年非复发死亡率为12.5%，而具有2个或更多风险因素的患者的3年非复发死亡率为46.2%。使用无关供体对非复发死亡率无不良影响。急性移植物抗宿主病（aGVHD）等级II-IV发展为30%，慢性GVHD为42%。cGVHD的发展与较低的复发率相关。1年和5年的疾病进展率分别为41%和58.7%，与化疗难治性疾病和既往治疗程度相关。对64例活动性疾病患者进行了供体淋巴细胞输注，其中32%显示出临床反应。18例接受供体淋巴细胞输注的患者中有8例出现临床反应。无进展生存期和总生存期均与移植时的体能状态和疾病状态相关。无任何危险因素的患者3年PFS和总生存率分别为42%和56%，而有一个或多个危险因素的患者为8%和25%。复发前自体移植6个月内与较高的复发率和较低的progression-free.ConclusionsThis分析确定了重要的临床参数，可能是有用的预测结果RICallCalloSCT霍奇金淋巴瘤。
BackgroundThe role of reduced intensity conditioning allogeneic stem transplantation (RICalloSCT) in the management of patients with Hodgkin's lymphoma remains controversial.Design and MethodsTo further define its role we have conducted a retrospective analysis of 285 patients with HL who underwent a RICalloSCT in order to identify prognostic factors that predict outcome. Eighty percent of patients had undergone a prior autologous stem cell transplantation and 25% had refractory disease at transplant.ResultsNon-relapse mortality was associated with chemorefractory disease, poor performance status, age >45 and transplantation before 2002. For patients with no risk factors the 3-year non-relapse mortality rate was 12.5% compared to 46.2% for patients with 2 or more risk factors. The use of an unrelated donor had no adverse effect on the non-relapse mortality. Acute graft versus host disease (aGVHD) grades II-IV developed in 30% and chronic GVHD in 42%. The development of cGVHD was associated with a lower relapse rate. The disease progression rate at one and five years was 41% and 58.7% respectively and was associated with chemorefractory disease and extent of prior therapy. Donor lymphocyte infusions were administered to 64 patients for active disease of whom 32% showed a clinical response. Eight out of 18 patients receiving donor lymphocyte infusions alone had clinical responses. Progression-free and overall survival were both associated with performance status and disease status at transplant. Patients with neither risk factor had a 3-year PFS and overall survival of 42% and 56% respectively compared to 8% and 25% for patients with one or more risk factors. Relapse within six months of a prior autologous transplant was associated with a higher relapse rate and a lower progression-free.ConclusionsThis analysis identifies important clinical parameters that may be useful in predicting the outcome of RICallCalloSCT in Hodgkin's lymphoma.