Autologous or Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Chemotherapy-Sensitive Mantle-Cell Lymphoma: Analysis of Transplantation Timing and Modality
Autologous or Reduced-Intensity Conditioning Allogeneic Hematopoietic Cell Transplantation for Chemotherapy-Sensitive Mantle-Cell Lymphoma: Analysis of Transplantation Timing and Modality
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DOI：
10.1200/jco.2013.49.2454
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发表时间：
2014-02-01
影响因子：
45.3
通讯作者：
Hari, Parameswaran N.
中科院分区：
文献类型：
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作者：
Fenske, Timothy S.;Zhang, Mei-Jie;Hari, Parameswaran N.
目的探讨化疗敏感的mantle-cell淋巴瘤（MCL）患者在首次造血干细胞移植（HCT）后的预后，比较自体（auto）与降低强度调节的同种异体（RIC allo） HCT以及在病程中不同时间进行移植的预后。患者和方法总共分析了1996年至2007年间接受移植并报告给国际血液和骨髓移植研究中心的519例患者。早期移植队列定义为首次部分缓解或完全缓解的患者，化疗不超过两条线。晚期移植队列定义为所有剩余患者。结果Auto-HCT和RIC allo-HCT在早期（5年：61% Auto-HCT vs 62% RIC allo-HCT； P = 0.951）和晚期（5年：44% Auto-HCT vs 31% RIC allo-HCT； P = 0.202）移植后的总生存率相似。在早期和晚期移植队列中，同种异体移植组的进展/复发较低，非复发死亡率较高。首次完全缓解时接受auto-HCT的患者总生存期和无进展生存期最高。从诊断开始的多变量生存分析发现，无论是auto-HCT还是RIC - allo-HCT，早期HCT都有利于生存。结论对于化疗敏感的MCL患者，HCT的最佳时机是在病程早期。在首次完全缓解时接受auto-HCT的患者的结果尤其有利。对于那些在两线化疗后无法达到完全缓解或疾病复发的患者，自体hct或RIC同种异体hct可能有效，尽管长期缓解和生存的机会较低。
Purpose To examine the outcomes of patients with chemotherapy-sensitive mantle-cell lymphoma (MCL) following a first hematopoietic stem-cell transplantation (HCT), comparing outcomes with autologous (auto) versus reduced-intensity conditioning allogeneic (RIC allo) HCT and with transplantation applied at different times in the disease course.Patients and Methods In all, 519 patients who received transplantations between 1996 and 2007 and were reported to the Center for International Blood and Marrow Transplant Research were analyzed. The early transplantation cohort was defined as those patients in first partial or complete remission with no more than two lines of chemotherapy. The late transplantation cohort was defined as all the remaining patients.Results Auto-HCT and RIC allo-HCT resulted in similar overall survival from transplantation for both the early (at 5 years: 61% auto-HCT v 62% RIC allo-HCT; P = .951) and late cohorts (at 5 years: 44% auto-HCT v 31% RIC allo-HCT; P = .202). In both early and late transplantation cohorts, progression/relapse was lower and nonrelapse mortality was higher in the allo-HCT group. Overall survival and progression-free survival were highest in patients who underwent auto-HCT in first complete response. Multivariate analysis of survival from diagnosis identified a survival benefit favoring early HCT for both auto-HCT and RIC allo-HCT.Conclusion For patients with chemotherapy-sensitive MCL, the optimal timing for HCT is early in the disease course. Outcomes are particularly favorable for patients undergoing auto-HCT in first complete remission. For those unable to achieve complete remission after two lines of chemotherapy or those with relapsed disease, either auto-HCT or RIC allo-HCT may be effective, although the chance for long-term remission and survival is lower.