Nachbaur David, Greinix Hildegard T, Koller Elisabeth, Krieger Otto, Linkesch Werner, Kasparu Hedwig, Pober Michael, Hinterberger Wolfgang, Hausmaninger Hubert, Heistinger Max, Ulsperger Ernst, Karlhuber Susanne, Schwinger Wolfgang, Lindner Beate
Clinical Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria.
Ann Hematol. 2005 Jul;84(7):462-73. doi: 10.1007/s00277-004-1003-3. Epub 2005 Feb 23.
Between 1990 and 2001, 68 patients with advanced Hodgkin's disease (HD) and 86 patients classified as low-/intermediate-grade B non-Hodgkin's lymphoma (NHL) were reported to the Austrian Stem Cell Transplantation Registry (ASCTR). Following autologous stem cell transplantation (SCT) for HD, overall survival was 56% [95% confidence interval (CI): 40-72%] with a disease-/progression-free survival of 49%, reaching a plateau at 5 years. Using multivariate Cox regression analysis BEAM conditioning (carmustine, cytarabine, etoposide and melphalan) was predictive for favourable outcome, better disease-/progression-free survival and a significantly lower risk for relapse. The cumulative incidence of relapse was 30%, even for patients in complete remission at time of SCT. The cumulative risk for developing a secondary malignancy increased continuously over time, achieving 20% at 7 years and 46% at 10 years with previous radiotherapy as the only risk factor in the multivariate analysis. Overall survival for NHL patients was 45% (95% CI: 26-64%) with a disease-/progression-free survival of 26% at 7 years. In the multivariate Cox regression analysis stage of disease at time of SCT was the most powerful parameter for overall survival, disease-/progression-free survival and relapse. Mantle cell lymphoma, greater than or equal to three lines of previous therapy, and a conditioning regimen other than BEAM were also predictive for death. The main reason for treatment failure was relapse (cumulative incidence 54-75%). Because of the high risk of relapse/progression in both disease categories and the additional high rate of second malignancies in HD patients, allogeneic stem cells should be considered a valuable alternative for selected patients. The efficacy of allotransplantation following reduced-intensity conditioning should be tested in randomised trials.
1990年至2001年期间，奥地利干细胞移植登记处（ASCTR）报告了68例晚期霍奇金淋巴瘤（HD）患者和86例被归类为低/中级B细胞非霍奇金淋巴瘤（NHL）的患者。HD患者接受自体干细胞移植（SCT）后，总生存率为56%[95%置信区间（CI）：40 - 72%]，无疾病/无进展生存率为49%，5年后达到平台期。使用多变量Cox回归分析，BEAM预处理方案（卡莫司汀、阿糖胞苷、依托泊苷和美法仑）对良好预后、更好的无疾病/无进展生存率以及显著更低的复发风险具有预测性。复发的累积发生率为30%，即使是SCT时处于完全缓解的患者。发生继发性恶性肿瘤的累积风险随时间持续增加，在多变量分析中，既往放疗作为唯一风险因素时，7年时达到20%，10年时达到46%。NHL患者的总生存率为45%（95%CI：26 - 64%），7年时无疾病/无进展生存率为26%。在多变量Cox回归分析中，SCT时的疾病分期是总生存率、无疾病/无进展生存率和复发的最有力参数。套细胞淋巴瘤、既往接受过三线及以上治疗以及非BEAM预处理方案也可预测死亡。治疗失败的主要原因是复发（累积发生率54 - 75%）。由于这两种疾病复发/进展风险高，且HD患者继发性恶性肿瘤发生率也高，对于选定患者，应考虑将异基因干细胞作为一种有价值的替代方案。应在随机试验中测试降低强度预处理后同种异体移植的疗效。
