Freytes César O, Loberiza Fausto R, Rizzo J Douglas, Bashey Asad, Bredeson Christopher N, Cairo Mitchell S, Gale Robert Peter, Horowitz Mary M, Klumpp Thomas R, Martino Rodrigo, McCarthy Philip L, Molina Arturo, Pavlovsky Santiago, Pecora Andrew L, Serna Derek S, Tsai Tsuong, Zhang Mei-Jie, Vose Julie M, Lazarus Hillard M, van Besien Koen
University of Texas Health Science Center, Mail Code 7880, 7703 Floyd Curl Dr, San Antonio, TX 78229-3900, USA.
Blood. 2004 Dec 1;104(12):3797-803. doi: 10.1182/blood-2004-01-0231. Epub 2004 Jul 27.
Myeloablative allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly used in patients with lymphoma who experience disease relapse after autologous hematopoietic stem cell transplantation (auto-HSCT) because the allograft is tumor free and may induce a graft-versus-tumor effect. We analyzed 114 patients treated with this approach from 1990 to 1999 to assess disease progression, progression-free survival (PFS), and overall survival (OS). Cumulative incidence of disease progression at 3 years was 52%, whereas treatment-related mortality was 22%, lower than previously reported. Three-year probabilities of OS and PFS were 33% and 25%, respectively. With prolonged follow-up, however, nearly all patients experienced disease progression, and 5-year probabilities were 24% and 5%, respectively. Complete remission at the time of allo-HSCT and use of total body irradiation (TBI) in patients with non-Hodgkin lymphoma (NHL) were associated with lower rates of disease progression and higher rates of OS. In summary, allo-HSCT is feasible for patients with lymphoma who have relapses after auto-HSCT and can result in prolonged survival for some, but it is usually not curative. Most likely to benefit are patients who have HLA-matched sibling donors, are in remission, and have good performance status.
清髓性异基因造血干细胞移植（allo-HSCT）越来越多地用于自体造血干细胞移植（auto-HSCT）后疾病复发的淋巴瘤患者，因为移植的异体造血干细胞无肿瘤且可能诱导移植物抗肿瘤效应。我们分析了1990年至1999年采用这种方法治疗的114例患者，以评估疾病进展、无进展生存期（PFS）和总生存期（OS）。3年时疾病进展的累积发生率为52%，而治疗相关死亡率为22%，低于先前报道。OS和PFS的3年概率分别为33%和25%。然而，随着随访时间延长，几乎所有患者都出现疾病进展，5年概率分别为24%和5%。allo-HSCT时达到完全缓解以及非霍奇金淋巴瘤（NHL）患者使用全身照射（TBI）与较低的疾病进展率和较高的OS率相关。总之，allo-HSCT对于auto-HSCT后复发的淋巴瘤患者是可行的，并且可以使部分患者生存期延长，但通常无法治愈。最有可能获益的是具有HLA匹配同胞供者、处于缓解期且身体状况良好的患者。
