Schimmer A D, Jamal S, Messner H, Keating A, Meharchand J, Huebsch L, Walker I, Benger A, Gluck S, Smith A
University Health Network, Princess Margaret Hospital, University of Toronto, Canada.
Bone Marrow Transplant. 2000 Oct;26(8):859-64. doi: 10.1038/sj.bmt.1702625.
In 1986, the bone marrow transplant centers in Ontario agreed to a strategy for the treatment of patients with NHL. Suitable patients would undergo autotransplant but be referred for allotransplant if they had persistent marrow involvement or an inadequate marrow/stem cell harvest. Data of all patients were recorded in a database. We reviewed this database to compare these transplant modalities with respect to overall survival, rate of relapse and treatment-related mortality. Between January 1986 and August 1997, 429 patients underwent BMT for NHL - 385 autotransplants and 44 allotransplants. Sixty-eight percent of patients received their transplant for aggressive NHL, while the others had indolent lymphoma. Three-year actuarial survival did not differ between allogeneic and autologous BMT: 71% vs 62%, respectively (P = 0.5330 by log-rank testing). Three-year actuarial rate of relapse was lower after allotransplant than autotransplant: 6% vs 41%, respectively (P = 0.0006 by log-rank testing). Treatment-related mortality was higher after allotransplant than autotransplant: 23% vs 6%, respectively (P = 0.001 by chi2 analysis). For further comparison, autotransplant patients were randomly matched 2:1 with the allotransplant patients for age +/- 5 years, disease status at BMT, disease histology, and year of BMT. In the matched comparison, survival did not differ (relative risk of death after allotransplant: 0.711 (95% CI: 0.309-1.637)). Relapse rate was significantly lower in the allotransplant group (relative risk of relapse for allotransplant: 0.190 (95% CI: 0.043-0.834)) and treatment-related mortality was not significantly different (relative risk for allotransplant: 1.425 (95% CI: 0.527-3.851)). In conclusion, a review of a provincial strategy for treatment of NHL, shows that survival is not different after allogeneic or autologous BMT, but the rate of relapse is lower after allotransplant. These data support continuing the current provincial strategy.
1986年，安大略省的骨髓移植中心商定了一项治疗非霍奇金淋巴瘤（NHL）患者的策略。合适的患者将接受自体移植，但如果他们存在持续性骨髓受累或骨髓/干细胞采集不足的情况，则会被转介进行异体移植。所有患者的数据都记录在一个数据库中。我们回顾了这个数据库，以比较这些移植方式在总生存率、复发率和治疗相关死亡率方面的情况。在1986年1月至1997年8月期间，429例患者因NHL接受了骨髓移植——385例自体移植和44例异体移植。68%的患者因侵袭性NHL接受移植，其余患者患有惰性淋巴瘤。异体骨髓移植和自体骨髓移植的三年精算生存率没有差异：分别为71%和62%（对数秩检验P = 0.5330）。异体移植后的三年精算复发率低于自体移植：分别为6%和41%（对数秩检验P = 0.0006）。异体移植后的治疗相关死亡率高于自体移植：分别为23%和6%（卡方分析P = 0.001）。为了进一步比较，根据年龄±5岁、骨髓移植时的疾病状态、疾病组织学以及骨髓移植年份，将自体移植患者与异体移植患者按2:1的比例进行随机匹配。在匹配比较中，生存率没有差异（异体移植后死亡的相对风险：0.711（95%可信区间：0.309 - 1.637））。异体移植组的复发率显著较低（异体移植复发的相对风险：0.190（95%可信区间：0.043 - 0.834）），且治疗相关死亡率没有显著差异（异体移植的相对风险：1.425（95%可信区间：0.527 - 3.851））。总之，对一项省级NHL治疗策略的回顾表明，异体或自体骨髓移植后的生存率没有差异，但异体移植后的复发率较低。这些数据支持继续采用当前的省级策略。
