非清髓性预处理后接受异基因造血细胞移植治疗的晚期慢性淋巴细胞白血病患者的五年随访
Five-year follow-up of patients with advanced chronic lymphocytic leukemia treated with allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning.
作者信息
Sorror Mohamed L, Storer Barry E, Sandmaier Brenda M, Maris Michael, Shizuru Judith, Maziarz Richard, Agura Edward, Chauncey Thomas R, Pulsipher Michael A, McSweeney Peter A, Wade James C, Bruno Benedetto, Langston Amelia, Radich Jerald, Niederwieser Dietger, Blume Karl G, Storb Rainer, Maloney David G
机构信息
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
出版信息
J Clin Oncol. 2008 Oct 20;26(30):4912-20. doi: 10.1200/JCO.2007.15.4757. Epub 2008 Sep 15.
PURPOSE
We reported encouraging early results of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning in 64 patients who had advanced chronic lymphocytic leukemia (CLL). Here, we have extended the follow-up to a median of 5 years and have included data on an additional 18 patients.
PATIENTS AND METHODS
Eighty-two patients, age 42 to 72 years, who had fludarabine-refractory CLL were conditioned with 2 Gy total-body irradiation alone or combined with fludarabine followed by HCT from related (n = 52) or unrelated (n = 30) donors.
RESULTS
Complete remission (CR) and partial remission were achieved in 55% and 15% of patients, respectively. Higher CR rates were noted after unrelated HCT (67% v 48%). The 5-year incidences of nonrelapse mortality (NRM), progression/relapse, overall survival, and progression-free survival were 23%, 38%, 50%, and 39%, respectively. Among 25 patients initially reported in CR, 8% relapsed and 8% died as a result of NRM, whereas 84% have remained alive and in CR. Among 14 responding patients who were tested and who had molecular eradication of their disease, two died as a result of NRM, two relapsed, and 10 have remained negative. At 5 years, 76% of living patients were entirely well, whereas 24% continued to receive immunosuppression for chronic graft-versus-host disease; the median performance status in each group was 100% and 90%, respectively. Lymphadenopathy > or = 5 cm, but not cytogenetic abnormalities at HCT, predicted relapse. In a risk-stratification model, patients who had lymphadenopathy less than 5 cm and no comorbidities had a 5-year OS of 71%.
CONCLUSION
Nonmyeloablative HCT resulted in a median survival of 5 years for patients who had fludarabine-refractory CLL with sustained remissions and in the continued resolution of chronic graft-versus-host disease in surviving patients.
目的
我们报告了64例晚期慢性淋巴细胞白血病（CLL）患者在非清髓性预处理后进行异基因造血细胞移植（HCT）的令人鼓舞的早期结果。在此，我们将随访时间延长至中位5年，并纳入了另外18例患者的数据。
患者与方法
82例年龄在42至72岁之间、对氟达拉滨耐药的CLL患者，接受单独2 Gy全身照射或联合氟达拉滨预处理，随后接受来自相关供者（n = 52）或无关供者（n = 30）的HCT。
结果
分别有55%和15%的患者达到完全缓解（CR）和部分缓解。无关供者HCT后的CR率更高（67%对48%）。非复发死亡率（NRM）、进展/复发、总生存期和无进展生存期的5年发生率分别为23%、38%、50%和39%。在最初报告为CR的25例患者中，8%复发，8%因NRM死亡，而84%仍存活且处于CR状态。在14例接受检测且疾病分子清除的缓解患者中，2例因NRM死亡，2例复发，10例仍为阴性。5年时，76%的存活患者完全康复，而24%因慢性移植物抗宿主病继续接受免疫抑制治疗；每组的中位体能状态分别为100%和90%。HCT时淋巴结病≥5 cm，但非细胞遗传学异常，可预测复发。在一个风险分层模型中，淋巴结病小于5 cm且无合并症的患者5年总生存期为71%。
结论
非清髓性HCT使氟达拉滨耐药的CLL患者中位生存期达5年，缓解持续，且存活患者的慢性移植物抗宿主病持续缓解。
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