Department of Hematology, University of Heidelberg, Heidelberg, Germany.
Cancer. 2011 May 1;117(9):1901-10. doi: 10.1002/cncr.25756. Epub 2010 Nov 29.
Autologous stem cell transplantation (autoSCT) has improved the outcome of patients with mantle cell lymphoma (MCL) considerably. However, little is known about the patterns and outcome of MCL recurrence after autoSCT.
The authors conducted a retrospective study of 118 patients with MCL who underwent autoSCT from August 1992 to August 2008 at 3 different referral centers in Germany.
Fifty-two relapses occurred for a cumulative incidence of 46% after 5 years. Only 3 patients relapsed after 5 years (at 90 months, 91 months, and 171 months) after undergoing autoSCT. A Cox regression analysis of the incidence of relapse identified not receiving rituximab before autoSCT and undergoing salvage autoSCT as predictive factors for relapse, whereas cytosine arabinoside intensification; a total body irradiation-based, high-dose regimen; patient age; and year of transplantation had no influence. The median overall survival (OS) after relapse was 23 months. Twenty patients (39%) underwent allogeneic stem cell transplantation (alloSCT) for relapse, and 11 of those patients remained in ongoing complete remission at the time of the current report. It is noteworthy that there were 4 long-term survivors who lived for >5 years after relapse even without undergoing alloSCT. A Cox regression analysis of OS after relapse revealed that the response duration after autoSCT was an adverse predictor of OS, whereas alloSCT was associated with a significantly longer OS after relapse.
The current results indicated that autoSCT was capable of inducing long-term remission up to 16 years after treatment, but the outcome of patients with MCL who relapsed after autoSCT was poor, especially if their response duration after autoSCT was short. However, for a subset of patients with relapsed MCL, alloSCT may offer the possibility of durable survival, and individual patients can enjoy long-term survival after relapse even without undergoing alloSCT.
自体干细胞移植（autoSCT）显著改善了套细胞淋巴瘤（MCL）患者的预后。然而，对于 MCL 患者在接受 autoSCT 后复发的模式和结局，我们知之甚少。
作者对 1992 年 8 月至 2008 年 8 月在德国 3 个不同转诊中心接受 autoSCT 的 118 例 MCL 患者进行了回顾性研究。
52 例患者发生了累积发生率为 46%的 52 次复发。仅 3 例患者在接受 autoSCT 后 5 年后（90 个月、91 个月和 171 个月）复发。Cox 回归分析复发的发生率发现，在接受 autoSCT 前未接受利妥昔单抗治疗和接受挽救性 autoSCT 是复发的预测因素，而阿糖胞苷强化；基于全身照射的大剂量方案；患者年龄；以及移植年份无影响。复发后的中位总生存期（OS）为 23 个月。20 例（39%）患者因复发而行异基因干细胞移植（alloSCT），其中 11 例患者在本报告时仍处于持续完全缓解状态。值得注意的是，有 4 例长期幸存者在没有接受 alloSCT 的情况下，复发后存活时间超过 5 年。对复发后 OS 的 Cox 回归分析显示，autoSCT 后的缓解持续时间是 OS 的不利预测因素，而 alloSCT 与复发后 OS 显著延长相关。
目前的结果表明，autoSCT 能够诱导长达 16 年的长期缓解，但 MCL 患者在接受 autoSCT 后复发的结局较差，特别是如果他们在 autoSCT 后的缓解持续时间较短。然而，对于 MCL 复发的患者亚组，alloSCT 可能提供持久生存的可能性，并且即使没有接受 alloSCT，个别患者也可以在复发后长期生存。
