Conditioning regimens for allotransplants for diffuse large B-cell lymphoma: myeloablative or reduced intensity?
Conditioning regimens for allotransplants for diffuse large B-cell lymphoma: myeloablative or reduced intensity?
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DOI：
10.1182/blood-2012-06-436725
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发表时间：
2012-11-15
期刊：
影响因子：
20.3
通讯作者：
Hari, Parameswaran N.
中科院分区：
文献类型：
--
作者：
Bacher, Ulrike;Klyuchnikov, Evgeny;Hari, Parameswaran N.
高危弥漫性大B细胞淋巴瘤（DLBCL）异基因移植前的最佳预处理方案仍有待澄清。我们分析了396例DLBCL同种异体移植受者的数据，这些受者接受了清髓性（MAC; n = 165）、降低强度（RIC; n = 143）或非清髓性预处理（NMAC; n = 88）方案。急性和慢性GVHD发生率在各组之间相似。MAC组的5年无复发死亡率（NRM）高于RIC组和NMAC组（56% vs 47% vs 36%; P = 0.007）。MAC组的5年复发/进展率低于RIC/NMAC组（26% vs 38% vs 40%; P = 0.031）。5年无进展生存率（15%-25%）和总生存率（18%-26%）在队列之间没有显著差异。在多变量分析中，NMAC和最近的移植年份与较低的NRM相关，而较低的Karnofsky表现评分（< 90），既往复发耐药治疗和使用无关供体与较高的NRM相关。NMAC移植、既往未使用利妥昔单抗和既往复发对治疗耐药与复发/进展风险更大相关。总之，RIC或NMAC的同种异体移植在选择的DLBCL患者中诱导了长期无进展生存，这些患者具有较低的NRM风险，但具有较高的淋巴瘤进展或复发风险。（血。2012; 120（20）：4256-4262）
The best conditioning regimen before allogeneic transplantation for high-risk diffuse large B-cell lymphoma (DLBCL) remains to be clarified. We analyzed data from 396 recipients of allotransplants for DLBCL receiving myeloablative (MAC; n = 165), reduced intensity (RIC; n = 143), or nonmyeloablative conditioning (NMAC; n = 88) regimens. Acute and chronic GVHD rates were similar across the groups. Five-year nonrelapse mortality (NRM) was higher in MAC than RIC and NMAC (56% vs 47% vs 36%; P = .007). Five-year relapse/progression was lower in MAC than in RIC/NMAC (26% vs 38% vs 40%; P = .031). Five-year progression-free survival (15%-25%) and overall survival (18%-26%) did not differ significantly between the cohorts. In multivariate analysis, NMAC and more recent transplant year were associated with lower NRM, whereas a lower Karnofsky performance score (< 90), prior relapse resistant to therapy, and use of unrelated donors were associated with higher NRM. NMAC transplants, no prior use of rituximab, and prior relapse resistant to therapy were associated with a greater risk of relapse/progression. In conclusion, allotransplantation with RIC or NMAC induces long-term progressionfree survival in selected DLBCL patients with a lower risk of NRM but with higher risk of lymphoma progression or relapse. (Blood. 2012; 120(20): 4256-4262)