Institute of Haematology and Blood Transfusion, Prague, Czech Republic.
Hematol Oncol. 2011 Mar;29(1):22-30. doi: 10.1002/hon.949.
In recent years, many studies have confirmed that allogeneic stem cell transplantation (allo-SCT) can provide long-term disease control and possible cure in selected patients with chronic lymphocytic leukaemia (CLL), including those with a biologically highly unfavourable risk profile. A retrospective analysis of allo-SCT in 30 patients with CLL whose risk profile was unfavourable and who were treated in the years 2000-2009 was performed. The aim was to compare the results of allo-SCT by prognostic factors and conditioning type and evaluate the results of unrelated transplantation. The median age was 54 years. Donors were 8 HLA-matched siblings and 22 unrelated volunteers, 11 of whom were mismatched. Eighteen patients were treated with reduced intensity conditioning. Twelve patients received myeloablative conditioning. Estimated overall survival (OS) at 3 years was 78%, progression-free survival (PFS) 71%, relapse incidence 10% and non-relapse mortality (NRM) 16%, respectively, with a median follow-up of 35 months. According to molecular/cytogenetic characteristics, OS and PFS for the high risk group (17p- or 11q-) were 89 and 77%, respectively, not significantly different from those with standard risk. Graft-versus-host disease (GVHD) was associated with greater toxicity; significantly higher NRM for patients with aGVHD (p = 0.04) and worse PFS for patients with cGVHD (p = 0.04). Our results for the refractory disease group (77% responses) indicate that chemoresistance may be overcome by the GVL effect. Transplants from unrelated donors may be considered comparable to those from related donors.
近年来，许多研究证实，同种异体干细胞移植（allo-SCT）可在某些慢性淋巴细胞白血病（CLL）患者中提供长期疾病控制和可能的治愈效果，包括那些生物学上高度不利的风险患者。本研究回顾性分析了 2000 年至 2009 年期间治疗的 30 例风险较高的 CLL 患者的 allo-SCT 结果。目的是通过预后因素和预处理类型比较 allo-SCT 的结果，并评估无关供体移植的结果。患者中位年龄为 54 岁。供者为 8 例 HLA 匹配的同胞和 22 例无关志愿者，其中 11 例不匹配。18 例患者接受强度降低的预处理，12 例患者接受清髓性预处理。3 年总生存率（OS）、无进展生存率（PFS）、复发率和非复发死亡率（NRM）分别为 78%、71%、10%和 16%，中位随访时间为 35 个月。根据分子/细胞遗传学特征，高危组（17p-或 11q-）的 OS 和 PFS 分别为 89%和 77%，与标准风险患者无显著差异。移植物抗宿主病（GVHD）与更大的毒性相关；GVHD 患者的 NRM 显著更高（p=0.04），cGVHD 患者的 PFS 更差（p=0.04）。我们对难治性疾病组（77%的缓解率）的结果表明，GVL 效应可能克服化疗耐药性。无关供体移植可被认为与亲缘供体移植相当。
