Department of Haematology, University College London, Pond St, London, NW3 2QG, United Kingdom.
J Clin Oncol. 2011 May 10;29(14):1855-63. doi: 10.1200/JCO.2010.32.8419. Epub 2011 Apr 11.
Historically, high levels of treatment-related mortality restricted the use of standard myeloablative allogeneic stem-cell transplantation to a minority of young and fit patients with lymphoma. Over the last decade, increasing numbers of patients with lymphoma have undergone allogeneic stem-cell transplantation using reduced-intensity protocols that are associated with lower toxicity and reduced transplantation-related mortality. Graft-versus-lymphoma effects contribute to the therapeutic effect in patients with indolent or Hodgkin's lymphoma. However, definitive evidence for efficacy of this strategy is lacking because most patients undergoing transplantation do so after failure of several lines of treatment, leaving no obvious comparator arm for randomized controlled studies. Nevertheless, encouraging results have been reported for selected patients for most lymphoma subtypes, with pretransplantation disease status emerging as the most important predictor of outcome. The major long-term toxicity is chronic graft-versus-host disease that contributes to ill health in a significant minority of survivors. In the future, risk-adapted trials that evaluate reduced-intensity allogeneic transplantation in patients with predicted poor outcomes with immunochemotherapy or autologous transplantation will be important in determining the role of this treatment.
从历史上看，由于治疗相关死亡率较高，标准的强化同种异体干细胞移植仅限于少数年轻和健康的淋巴瘤患者。在过去的十年中，越来越多的淋巴瘤患者接受了强度降低的同种异体干细胞移植方案，这些方案与较低的毒性和降低的移植相关死亡率相关。移植物抗淋巴瘤效应有助于惰性或霍奇金淋巴瘤患者的治疗效果。然而，由于大多数接受移植的患者在多次治疗失败后才进行移植，因此缺乏明确的随机对照研究对照臂，因此缺乏这种策略疗效的明确证据。然而，对于大多数淋巴瘤亚型的选定患者，已经报告了令人鼓舞的结果，移植前疾病状态是预后的最重要预测因素。主要的长期毒性是慢性移植物抗宿主病，这会导致少数幸存者的健康状况不佳。在未来，评估免疫化疗或自体移植后预测预后不良的患者接受强度降低的同种异体移植的风险适应试验，对于确定这种治疗的作用将非常重要。
