异基因干细胞移植可能会克服慢性淋巴细胞白血病患者未突变VH基因的不良预后。

Allogeneic stem-cell transplantation may overcome the adverse prognosis of unmutated VH gene in patients with chronic lymphocytic leukemia.

作者信息

Moreno Carol, Villamor Neus, Colomer Dolors, Esteve Jordi, Martino Rodrigo, Nomdedéu Josep, Bosch Francesc, López-Guillermo Armando, Campo Elías, Sierra Jorge, Montserrat Emili

机构信息

Department of Hematology, Institute of Hematology and Oncology, Hospital Clínic, Villarroel, 170, 08036 Barcelona, Spain.

出版信息

J Clin Oncol. 2005 May 20;23(15):3433-8. doi: 10.1200/JCO.2005.04.531. Epub 2005 Apr 4.

DOI:10.1200/JCO.2005.04.531

PMID:15809449

Abstract

PURPOSE

To investigate whether allogeneic stem-cell transplantation (allo-SCT) may overcome the negative impact of unmutated VH genes in the outcome of patients with chronic lymphocytic leukemia (CLL).

PATIENTS AND METHODS

We analyzed the outcome of patients who underwent SCT according to their VH mutational status.

RESULTS

Thirty-four patients (14 allo-SCT and 20 autologous SCT [auto-SCT]) presented unmutated VH genes and 16 patients presented mutated VH genes (nine allo-SCT and seven auto-SCT). Tumoral burden pre-SCT was significantly higher in the allo-SCT patients independent of the VH mutational status. The risk of relapse was significantly higher after auto-SCT (5-year risk, 61%; 95% CI, 44% to 84%) than after allo-SCT (5-year risk 12%, 95% CI, 3% to 44%; P < .05). In the unmutated group, 13 of 20 auto-SCT and two of 14 allo-SCT patients experienced disease progression, with a risk of relapse at 5 years of 66% (95% CI, 48% to 93%) v 17% (95% CI, 5% to 60%), respectively (P = .01).

CONCLUSION

These results show that allo-SCT may overcome the unfavorable effect of unmutated VH genes in patients with CLL.

摘要

目的

研究异基因干细胞移植（allo-SCT）是否可克服未突变VH基因对慢性淋巴细胞白血病（CLL）患者预后的负面影响。

患者与方法

我们根据VH突变状态分析了接受干细胞移植患者的预后情况。

结果

34例患者（14例接受异基因干细胞移植，20例接受自体干细胞移植[auto-SCT]）存在未突变的VH基因，16例患者存在突变的VH基因（9例接受异基因干细胞移植，7例接受自体干细胞移植）。无论VH突变状态如何，异基因干细胞移植患者移植前的肿瘤负荷均显著更高。自体干细胞移植后的复发风险（5年风险为61%；95%CI，44%至84%）显著高于异基因干细胞移植后（5年风险为12%，95%CI，3%至44%；P<.05）。在未突变组中，20例接受自体干细胞移植的患者中有13例、14例接受异基因干细胞移植的患者中有2例出现疾病进展，5年复发风险分别为66%（95%CI，48%至93%）和17%（95%CI，5%至60%）（P =.01）。