Wu Peggy A, Kim Youn H, Lavori Phillip W, Hoppe Richard T, Stockerl-Goldstein Keith E
Division of Dermatology, Washington University, St. Louis, Missouri 63110, USA.
Biol Blood Marrow Transplant. 2009 Aug;15(8):982-90. doi: 10.1016/j.bbmt.2009.04.017.
The survival outlook in advanced mycosis fungoides (MF) is poor. Autologous and allogeneic stem cell transplants (SCT) have been shown, in small case series and case reports, to have the potential for long-term remission or to alter disease course. Allogeneic SCT is thought to have a curative potential secondary to a graft-versus-lymphoma (GVL) effect. A patient-level meta-analysis was performed to compare the outcome of allogeneic versus autologous SCT in patients with MF/Sézary syndrome (SS) using 39 cases from the literature. There were a total of 20 allogeneic and 19 autologous transplant cases. The gender, age, and stage distribution was similar between the transplant groups. The allogeneic group received significantly more systemic therapies prior to transplant (P < .0005) and had longer follow-up after transplant. Overall survival (OS) results showed a more favorable outcome of patients who received allogeneic SCT (P = .027). Event-free survival (EFS) demonstrated a more durable response in patients who received allogeneic SCT (P = .002). In the allogeneic group, the majority (70%) of patients experienced persistent graft-versus-host disease (GVHD), mostly with mild to moderate severity, and 2 of 4 deaths were related to GVHD. Meanwhile, the majority of the deaths (8 of 10) in the autologous group were because of progressive disease. These results support the belief that allogeneic SCT offers a better survival and disease-free outcome versus autologous SCT in MF/SS, likely because of a GVL effect.
晚期蕈样肉芽肿（MF）的生存前景不佳。在小型病例系列和病例报告中，自体和异基因干细胞移植（SCT）已显示出有实现长期缓解或改变疾病进程的潜力。异基因SCT被认为由于移植物抗淋巴瘤（GVL）效应而具有治愈潜力。进行了一项患者水平的荟萃分析，使用文献中的39例病例比较MF/塞扎里综合征（SS）患者接受异基因与自体SCT的结果。共有20例异基因移植病例和19例自体移植病例。移植组之间的性别、年龄和分期分布相似。异基因组在移植前接受的全身治疗显著更多（P <.0005），且移植后的随访时间更长。总生存（OS）结果显示，接受异基因SCT的患者预后更有利（P =.027）。无事件生存（EFS）表明，接受异基因SCT的患者反应更持久（P =.002）。在异基因组中，大多数（70%）患者经历了持续性移植物抗宿主病（GVHD），大多为轻度至中度，4例死亡中有2例与GVHD相关。同时，自体组中的大多数死亡（10例中有8例）是由于疾病进展。这些结果支持了这样一种观点，即在MF/SS中，与自体SCT相比，异基因SCT能提供更好的生存和无病结局，这可能是由于GVL效应。
