Division of Clinical Hematology, Hospital de la Santa Creu i, Sant Pau St Antoni M Claret 167 Barcelona 08021, Spain.
Haematologica. 2010 Jul;95(7):1176-82. doi: 10.3324/haematol.2009.017608. Epub 2010 Jan 27.
Allogeneic hematopoietic stem cell transplantation is an effective treatment for patients with poor risk lymphoma, at least in part because of the graft-versus-lymphoma effect. Over the past decade, reduced intensity conditioning regimens have been shown to offer results similar to those of conventional high-dose conditioning regimens but with lower toxicity early after transplantation, especially in patients with chemosensitive disease at transplant.
The aim of this study was to analyze the long-term outcome of patients with follicular lymphoma who received an HLA identical sibling allogeneic stem cell transplant with a reduced intensity conditioning regimen within prospective trials. The prospective multicenter studies considered included 37 patients with follicular lymphoma who underwent allogeneic stem cell transplantation between 1998 and 2007 with a fludarabine plus melphalan-based reduced intensity conditioning regimen.
The median age of the patients was 50 years (range, 34-62 years) and the median follow-up was 52 months (range, 0.6 to 113 months). Most patients (77%) had stage III-IV at diagnosis, and patients had received a median of three lines of therapy before the reduced intensity conditioning allogeneic stem cell transplantation. At the time of transplantation, 14 patients were in complete remission, 16 in partial remission and 7 had refractory or progressive disease after salvage chemotherapy. The 4-year overall survival rates for patients in complete remission, partial remission, or with refractory or progressive disease were 71%, 48% and 29%, respectively (P=0.09), whereas the 4-year cumulative incidences of non-relapse mortality were 26% (95% CI, 11-61), 33% (95% CI, 16-68) and 71% (95% CI, 44-100), respectively. The incidence of relapse for the whole group was only 8% (95% CI, 2-23).
We conclude that this strategy of reduced intensity conditioning allogeneic stem cell transplantation may be associated with significant non-relapse mortality in heavily pre-treated patients with follicular lymphoma, but a remarkably low relapse rate. Long-term survival is likely in patients without progressive or refractory disease at the time of transplantation.
异基因造血干细胞移植是治疗高危淋巴瘤患者的有效方法，至少部分原因是移植物抗淋巴瘤效应。在过去的十年中，已经证明强度降低的预处理方案与传统高剂量预处理方案的结果相似，但在移植后早期毒性较低，尤其是在移植时患有化疗敏感疾病的患者中。
本研究的目的是分析在前瞻性试验中接受 HLA 相同的同胞异基因干细胞移植且预处理方案为强度降低的滤泡性淋巴瘤患者的长期结果。考虑到的前瞻性多中心研究包括 37 名在 1998 年至 2007 年间接受基于氟达拉滨和马法兰的强度降低预处理方案的异基因干细胞移植的滤泡性淋巴瘤患者。
患者的中位年龄为 50 岁（范围，34-62 岁），中位随访时间为 52 个月（范围，0.6-113 个月）。大多数患者（77%）在诊断时处于 III-IV 期，并且在接受强度降低的预处理异基因干细胞移植前，患者接受了中位数为三线的治疗。在移植时，14 名患者处于完全缓解，16 名处于部分缓解，7 名患者在挽救性化疗后出现难治性或进行性疾病。完全缓解、部分缓解或难治性或进行性疾病患者的 4 年总生存率分别为 71%、48%和 29%（P=0.09），而 4 年非复发死亡率的累积发生率分别为 26%（95%CI，11-61）、33%（95%CI，16-68）和 71%（95%CI，44-100）。整个组的复发率仅为 8%（95%CI，2-23）。
我们得出结论，对于滤泡性淋巴瘤的大量预处理患者，强度降低的预处理异基因干细胞移植策略可能与显著的非复发死亡率相关，但复发率极低。在移植时无进行性或难治性疾病的患者，长期生存是可能的。
