Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Bone Marrow Transplant. 2011 Jun;46(6):827-34. doi: 10.1038/bmt.2010.188. Epub 2010 Aug 23.
Salvage reinduction therapy followed by high-dose chemotherapy (HDCT) and auto-SCT is the treatment of choice for fit patients with refractory or relapsed aggressive non-Hodgkin's lymphoma (NHL). We assessed the prognostic value of comorbidity at the time of relapse to predict receipt of auto-SCT and outcome. We analyzed 156 consecutive NHL patients, referred to our center between 1999 and 2007 for salvage reinduction therapy, followed by HDCT and auto-SCT. Comorbidity according to the hematopoietic SCT comorbidity index was scored at relapse and directly before HDCT and auto-SCT. Primary end points were actual receipt of auto-SCT and survival. At relapse, comorbidity scores of 0, 1-2 and ≥3 were found among 64 (41%), 62 (40%) and 30 (19%) patients, respectively. Ultimately, 95 patients received auto-SCT. Higher comorbidity scores at relapse were associated with significantly less chance of receiving auto-SCT and with inferior OS, independently from secondary age-adjusted International Prognostic Index (sAAIPI) scores. For transplanted patients, OS rates at 5 years were 62, 30 and 17% for relapse comorbidity scores of 0, 1-2 and ≥3, respectively. In patients with relapsed NHL, comorbidity at relapse is associated with receipt of auto-SCT and subsequent survival independently from the sAAIPI.
挽救性再诱导治疗后接受大剂量化疗（HDCT）和自体造血干细胞移植（auto-SCT）是适合接受治疗的耐药或复发侵袭性非霍奇金淋巴瘤（NHL）患者的首选治疗方法。我们评估了复发时合并症的预后价值，以预测接受自体 SCT 和结果。我们分析了 156 例连续 NHL 患者，这些患者于 1999 年至 2007 年期间因挽救性再诱导治疗、随后接受 HDCT 和自体 SCT 而被转诊至我们中心。在复发时以及在接受 HDCT 和自体 SCT 之前，根据造血干细胞移植合并症指数对合并症进行评分。主要终点是实际接受自体 SCT 和生存。在复发时，分别有 64 例（41%）、62 例（40%）和 30 例（19%）患者的合并症评分为 0、1-2 和≥3。最终，有 95 例患者接受了自体 SCT。复发时合并症评分较高与接受自体 SCT 的机会明显减少和 OS 较差显著相关，独立于调整后的年龄校正国际预后指数（sAAIPI）评分。对于接受移植的患者，复发时合并症评分为 0、1-2 和≥3 的患者 5 年 OS 率分别为 62%、30%和 17%。在复发 NHL 患者中，复发时的合并症与接受自体 SCT 和随后的生存有关，独立于 sAAIPI。
