Allogeneic hematopoietic stem cell transplantation for ATL with central nervous system involvement: The Nagasaki Transplant Group experience
Allogeneic hematopoietic stem cell transplantation for ATL with central nervous system involvement: The Nagasaki Transplant Group experience
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DOI：
10.1007/s12185-011-0935-3
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发表时间：
2011-10-01
影响因子：
2.1
通讯作者：
Miyazaki, Yasushi
中科院分区：
文献类型：
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作者：
Fukushima, Takuya;Taguchi, Jun;Miyazaki, Yasushi
异基因造血干细胞移植（allo-HSCT）被认为是治疗侵袭性成人T细胞白血病-淋巴瘤（ATL）的一种选择。然而，allo-HSCT治疗对化疗高度耐药的伴有中枢神经系统（CNS）受累的ATL的疗效和安全性仍存在争议。我们分析了2000年至2007年间在长崎县三家机构接受allo-HSCT的10例累及CNS的ATL患者。3年总生存率为40%，4例存活患者的中位观察时间为1532天（范围945-2212天）。四个存活的患者中有两个接受了高度密集的中枢神经系统局部治疗;一个接受了26次鞘内注射抗肿瘤药物，另一个在移植前接受了全脑照射。然而，另外两名患者接受了常规或强度降低的预处理和标准鞘内化疗。四名存活患者中有三名经历了慢性GVHD，三名患有3级或4级急性GVHD的患者中有两名没有CNS复发。从这些数据来看，CNS疾病的强化局部治疗和全身性GVHD似乎都有助于CNS受累的长期控制。尽管我们的数据表明allo-HSCT是ATL合并CNS疾病的治疗选择，但移植相关的高死亡率（6例）表明需要进一步研究，以开发更有效的CNS疾病治疗方法，并降低移植相关的发病率。
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is regarded as a curative option for aggressive adult T cell leukemia-lymphoma (ATL). However, the efficacy and safety of allo-HSCT for ATL with central nervous system (CNS) involvement, which is highly resistant to chemotherapy, remain controversial. We analyzed 10 ATL patients with CNS involvement who received allo-HSCT at three institutions in Nagasaki prefecture between 2000 and 2007. The 3-year overall survival rate was 40%, and the median observation time of the four surviving patients was 1532 days (range 945-2212 days). Two of four surviving patients received highly intensive local treatment for the CNS; one with 26 intrathecal injections of antineoplastic agents, and the other with whole cerebrospinal irradiation before transplantation. However, the other two patients received conventional or reduced-intensity conditioning with standard intrathecal chemotherapy. Three of the four surviving patients experienced chronic GVHD, and two of three patients with grade 3 or 4 acute GVHD were free from CNS relapse. From these data, it seems that both intensive local treatment for CNS disease and systemic GVHD contributed to the long-term control of CNS involvement. Although our data suggest that allo-HSCT is a therapeutic option for ATL with CNS disease, high transplant-related mortality (six cases) indicates the need for further studies to develop more effective procedures for CNS disease, and to reduce transplant-related morbidity.