Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, CRC/Room 4-3152, Bethesda, MD 20892, USA.
Cancer. 2010 Feb 15;116(4):852-62. doi: 10.1002/cncr.24845.
Chemotherapy sensitivity, defined simply as at least a partial response to chemotherapy, is an important outcome predictor for non-Hodgkin lymphoma (NHL) patients undergoing reduced-intensity allogeneic hematopoietic stem cell transplantation (allo-HCT). The authors hypothesized that further differentiation of chemotherapy sensitivity by specific response, complete remission (CR) versus partial remission (PR) versus stable disease (SD) versus progression of disease (PD), correlates with post-transplant outcomes.
The impact of pretransplant and early (28 days) post-transplant disease response on transplant outcomes was analyzed in 63 NHL patients treated with reduced-intensity allo-HCT.
The 3-year event-free survival (EFS) and overall survival (OS) (median potential follow-up after reduced-intensity allo-HCT = 58 months) for all patients was 37% and 47%, respectively. The 3-year EFS based on pretransplant response was: CR = 50%; PR = 66%; SD = 18%; no patient with PD pretransplant reached 3-year follow-up. The 3-year OS based on pretransplant response was: CR = 63%; PR = 69%; SD = 45%. The 3-year EFS based on post-transplant response was: CR = 57%; PR = 32%; SD = 33%; no patient with PD post-transplant reached 3-year follow-up. The 3-year OS based on post-transplant response was: CR = 65%; PR = 43%; SD = 50%. In multivariate analyses, pretransplant response was the best predictor of EFS (P < .0001). Pretransplant response (P < .0001) and age (P = .0035) were jointly associated with OS.
These data suggest that NHL patients with pretransplant SD, generally considered inappropriate candidates, may benefit from reduced-intensity allo-HCT, and patients with pretransplant PD should only receive this therapy in clinical trials.
化疗敏感性，简单定义为对化疗至少有部分反应，是接受低强度异基因造血干细胞移植（allo-HCT）的非霍奇金淋巴瘤（NHL）患者的重要预后预测指标。作者假设，通过特定反应（完全缓解[CR]、部分缓解[PR]、稳定疾病[SD]和疾病进展[PD]）进一步区分化疗敏感性与移植后结局相关。
分析了 63 例接受低强度 allo-HCT 治疗的 NHL 患者的移植前和早期（28 天）疾病反应对移植结局的影响。
所有患者的 3 年无事件生存率（EFS）和总生存率（OS）（低强度 allo-HCT 后潜在中位随访时间为 58 个月）分别为 37%和 47%。基于移植前反应的 3 年 EFS 为：CR=50%；PR=66%；SD=18%；无移植前 PD 的患者达到 3 年随访。基于移植前反应的 3 年 OS 为：CR=63%；PR=69%；SD=45%。基于移植后反应的 3 年 EFS 为：CR=57%；PR=32%；SD=33%；无移植后 PD 的患者达到 3 年随访。基于移植后反应的 3 年 OS 为：CR=65%；PR=43%；SD=50%。多变量分析显示，移植前反应是 EFS 的最佳预测指标（P<0.0001）。移植前反应（P<0.0001）和年龄（P=0.0035）与 OS 均相关。
这些数据表明，通常被认为不适合移植的移植前 SD 的 NHL 患者可能从低强度 allo-HCT 中获益，而移植前 PD 的患者仅应在临床试验中接受这种治疗。
