Department of Hematology, ICO-Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain.
J Clin Oncol. 2010 Oct 10;28(29):4492-9. doi: 10.1200/JCO.2010.29.3241. Epub 2010 Aug 9.
To analyze the outcome of allogeneic transplantation for mycosis fungoides and Sézary syndrome (MF/SS) in terms of nonrelapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) and to identify factors associated with the outcome.
Sixty patients with MF (n = 36) and SS (n = 24) who received a first allogeneic hematopoietic cell transplantation (HCT) from a matched related (mRD; n = 45) or unrelated donor (mUD; n = 15) between 1997 and 2007 and who were registered in the European Group for Blood and Marrow Transplantation database were analyzed: 37 men and 23 women, median age 46.5 years (range, 22 to 66 years). Forty-four patients had TNM stage IV, and 40 patients were at advanced phase at transplantation. Forty-four patients received reduced-intensity conditioning (RIC) regimens, and 25 underwent T-cell depletion (TCD).
Allogeneic transplantation in MF/SS offers an estimated OS of 66% at 1 year and 54% at 3 years, primarily driven by donor type, disease phase, and type of conditioning. RIC decreased NRM (relative risk [RR] = 4.7; P = .008) without increasing REL, leading to a higher OS (RR = 2.8; P = .03). Advanced-phase disease increases REL (RR = 3.0; P = .03) and reduces PFS (RR = 4.4; P = .002) and OS (RR = 3.5; P = .023). Recipients of mRD allogeneic HCT had better PFS (RR = 2.7; P = .006) and OS (RR = 4.0; P = .001) than their mUD counterparts. The risk of REL increases with TCD (RR = 3.2; P = .005). Some patients who experience relapse can successfully undergo rescue treatment with donor lymphocyte infusions.
Allogeneic transplantation is a valid therapeutic alternative for high-risk patients with advanced-stage MF/SS. Our data also suggest the existence of a clinically relevant graft-versus-lymphoma effect in MF/SS.
分析异基因造血干细胞移植（allo-HCT）治疗蕈样真菌病和赛泽里综合征（MF/SS）患者的非复发死亡率（NRM）、复发/进展（REL）、无进展生存（PFS）和总生存（OS），并确定与结局相关的因素。
对 1997 年至 2007 年间在欧洲血液和骨髓移植协会数据库中登记的 60 例接受同胞相关（mRD；n=45）或无关供者（mUD；n=15）allo-HCT 的 MF（n=36）和 SS（n=24）患者进行分析：男 37 例，女 23 例，中位年龄 46.5 岁（范围 22-66 岁）。44 例患者为 TNM 分期 IV 期，40 例患者在移植时处于晚期。44 例患者接受了减低强度预处理（RIC）方案，25 例患者接受了 T 细胞耗竭（TCD）。
MF/SS 患者接受 allo-HCT 治疗的估计 1 年 OS 为 66%，3 年 OS 为 54%，主要与供者类型、疾病阶段和预处理类型有关。RIC 降低了 NRM（相对危险[RR]为 4.7；P=.008），而不增加 REL，从而提高了 OS（RR=2.8；P=.03）。晚期疾病增加了 REL（RR=3.0；P=.03），降低了 PFS（RR=4.4；P=.002）和 OS（RR=3.5；P=.023）。接受 mRD allo-HCT 的患者具有更好的 PFS（RR=2.7；P=.006）和 OS（RR=4.0；P=.001）。与 mUD 相比，接受 TCD 的患者 REL 风险增加（RR=3.2；P=.005）。一些发生复发的患者可以通过供者淋巴细胞输注成功进行挽救性治疗。
allo-HCT 是治疗高危、晚期 MF/SS 患者的有效治疗选择。我们的数据还表明，MF/SS 中存在一种具有临床相关性的移植物抗淋巴瘤效应。
