Fanning S R, Rybicki L, Kalaycio M, Andresen S, Kuczkowski E, Pohlman B, Sobecks R, Sweetenham J, Bolwell B
Department of Hematology and Medical Oncology, Taussig Cancer Center, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
Br J Haematol. 2006 Nov;135(3):374-81. doi: 10.1111/j.1365-2141.2006.06323.x. Epub 2006 Sep 22.
Mucositis is a known complication of autologous stem cell transplantation (ASCT). This study retrospectively reviewed 191 patients with lymphoid malignancies undergoing ASCT following a uniform mobilising regimen of etoposide (VP-16)/granulocyte colony-stimulating factor and a uniform high-dose preparative regimen of busulfan/cyclophosphamide/VP-16. Eighty-seven patients experienced severe mucositis (modified Oral Mucositis Assessment Scale > or =1). Patient characteristics compared between mucositis groups were balanced according to disease status, prior exposure to radiation therapy, time from radiation therapy and actual body weight. Log-rank analysis revealed that severe mucositis was associated with inferior overall survival (P = 0.002). A 12-month landmark analysis showed this difference in survival occurred within 1 year post-transplant. Multivariate analysis of all-cause mortality showed lower pretransplant albumin and severe mucositis to be significant risk factors. Multivariate analysis for relapse mortality revealed severe mucositis to be a risk factor (P = 0.047), while lower pretransplant albumin was significant for non-relapse mortality (NRM; P = 0.009). Kaplan-Meier estimates of survival based on relapse and NRM were significantly worse for patients with severe mucositis. Reduced pretransplant forced expiratory volume in 1 s (FEV(1)) and carbon monoxide (CO) diffusing capacity (DLCO) were also associated with severe mucositis. Our data suggest that studies of new treatment strategies for mucositis should include relapse and survival endpoints and that pretransplant factors, such as FEV(1) and DLCO may be useful to risk-stratify patients entered onto such trials.
黏膜炎是自体干细胞移植（ASCT）已知的并发症。本研究回顾性分析了191例接受ASCT的淋巴系统恶性肿瘤患者，这些患者采用了统一的依托泊苷（VP - 16）/粒细胞集落刺激因子动员方案以及统一的白消安/环磷酰胺/VP - 16大剂量预处理方案。87例患者发生了严重黏膜炎（改良口腔黏膜炎评估量表≥1）。根据疾病状态、既往放疗史、放疗时间和实际体重，对黏膜炎组之间的患者特征进行了均衡比较。对数秩分析显示，严重黏膜炎与总体生存率较低相关（P = 0.002）。一项12个月的标志性分析表明，这种生存差异发生在移植后1年内。全因死亡率的多变量分析显示，移植前白蛋白水平较低和严重黏膜炎是显著的危险因素。复发死亡率的多变量分析显示，严重黏膜炎是一个危险因素（P = 0.047），而移植前白蛋白水平较低对非复发死亡率（NRM）有显著影响（P = 0.009）。对于严重黏膜炎患者，基于复发和NRM的Kaplan - Meier生存估计值明显更差。移植前1秒用力呼气量（FEV(1)）和一氧化碳（CO）弥散量（DLCO）降低也与严重黏膜炎相关。我们的数据表明，黏膜炎新治疗策略的研究应包括复发和生存终点，并且移植前因素，如FEV(1)和DLCO，可能有助于对参与此类试验的患者进行风险分层。
