Woessmann Willi, Peters Christina, Lenhard Meike, Burkhardt Birgit, Sykora Karl-Walter, Dilloo Dagmar, Kremens Bernhard, Lang Peter, Führer Monika, Kühne Thomas, Parwaresch Reza, Ebell Wolfram, Reiter Alfred
Department of Paediatric Haematology and Oncology, Justus-Liebig-University, D-35392 Giessen, Germany.
Br J Haematol. 2006 Apr;133(2):176-82. doi: 10.1111/j.1365-2141.2006.06004.x.
Patients with refractory or early relapsed anaplastic large cell lymphoma (ALCL) have a poor chance of survival. We report 20 children and adolescents with high-risk relapsed or refractory ALCL who underwent allogeneic haematopoietic stem cell transplantation (HSCT). We retrospectively analysed 20 patients who relapsed between December 1991 and April 2003 during (six patients) or soon after first-line Berlin-Frankfurt-Münster-type chemotherapy (14 patients) and underwent allogeneic HSCT. Nine patients received allogeneic HSCT after the first relapse and 11 after multiple relapses. Eight patients received their transplants from matched sibling donors, eight from unrelated donors and four from haploidentical family donors. The conditioning regimen was based on total body irradiation in 15 patients. Two patients relapsed after allogeneic HSCT and died. Three patients died of transplant-related toxicity. Event-free survival at 3 years after allogeneic transplant was 75 +/- 10%. There was no influence of donor type or conditioning regimen on outcome. Two of six patients with progressive disease during frontline therapy survived compared with 13/14 patients with a first relapse after frontline therapy. Two of three patients who were transplanted with active lymphoma and all five patients who received allogeneic HSCT for relapse following autologous HSCT survived disease-free. Allogeneic HSCT is effective and has acceptable toxicity as rescue therapy for high-risk ALCL relapse. It even offers cure for patients refractory to chemotherapy, suggesting a graft-versus-ALCL effect.
难治性或早期复发的间变性大细胞淋巴瘤（ALCL）患者的生存机会渺茫。我们报告了20例接受异基因造血干细胞移植（HSCT）的高危复发或难治性ALCL儿童和青少年患者。我们回顾性分析了20例于1991年12月至2003年4月期间在一线柏林-法兰克福-明斯特型化疗期间（6例）或之后不久（14例）复发并接受异基因HSCT的患者。9例患者在首次复发后接受了异基因HSCT，11例在多次复发后接受了该治疗。8例患者从匹配的同胞供体接受移植，8例从无关供体接受移植，4例从单倍体家族供体接受移植。15例患者的预处理方案基于全身照射。2例患者在异基因HSCT后复发并死亡。3例患者死于移植相关毒性。异基因移植后3年的无事件生存率为75±10%。供体类型或预处理方案对预后无影响。一线治疗期间疾病进展的6例患者中有2例存活，而一线治疗后首次复发的14例患者中有13例存活。3例移植时仍有活动性淋巴瘤的患者中有2例存活，所有5例自体HSCT后复发接受异基因HSCT的患者均无病存活。异基因HSCT作为高危ALCL复发的挽救治疗有效且毒性可接受。它甚至能治愈化疗难治的患者，提示存在移植物抗ALCL效应。
