组织学和进展时间可预测接受减低强度预处理和异基因造血细胞移植后复发的淋巴瘤的生存情况。
Histology and time to progression predict survival for lymphoma recurring after reduced-intensity conditioning and allogeneic hematopoietic cell transplantation.
机构信息
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
出版信息
Biol Blood Marrow Transplant. 2011 Oct;17(10):1537-45. doi: 10.1016/j.bbmt.2011.03.010. Epub 2011 Apr 12.
Reduced-intensity conditioning (RIC) before allogeneic hematopoietic cell transplantation (HCT) is increasingly used as a potentially curative option for patients with advanced lymphoma; however, relapse remains a major challenge. Unfortunately, little data are available on outcomes, predictors of survival, and results of specific management strategies in these patients. In the present study, a total of 101 consecutive relapses occurred and were evaluated in 280 patients with lymphoma who underwent RIC HCT. Diseases included aggressive non-Hodgkin lymphoma (NHL) (n = 42), indolent NHL (n = 33), and Hodgkin lymphoma (HL) (n = 26). Median time to relapse was 90 days (range, 3-1275 days), and graft-versus-host disease at relapse was present in 56 patients (55%). Interventions after relapse included no therapy (n = 14), withdrawal of immunosuppression alone (n = 11), chemoradiotherapy (n = 60), and donor lymphocyte infusion/second HCT (n = 16). Overall survival (OS) was 33% (95% confidence interval [CI], 23%-44%) at 3 years after relapse and 23% (95% CI, 13%-34%) at 5 years after relapse. Both aggressive NHL (vs indolent disease; hazard ratio, 2.29; P = .008) and relapse within 1 month post-HCT (vs >6 months; hazard ratio, 3.17; P = .004) were associated with increased mortality. Estimated 3-year OS was 16% (95% CI, 5%-32%) after relapse for aggressive NHL, 40% (95% CI, 19%-61%) after relapse for indolent NHL, and 47% (95% CI, 29%-64%) after relapse for HL. The 1-year survival was 24% for patients relapsing within 1 month post-HCT, compared with 52% for those relapsing at 1-3 months, 74% for those relapsing at 3-6 months, and 77% for those relapsing at more than 6 months. We conclude that despite relapse of lymphoma after RIC HCT, some patients may experience prolonged survival, with better postrelapse outcomes occurring in patients with indolent NHL, HL, or late relapse.
RIC 预处理在异基因造血细胞移植（HCT）前越来越多地被用作治疗晚期淋巴瘤患者的潜在治愈选择；然而，复发仍然是一个主要的挑战。不幸的是，在这些患者中，关于结局、生存预测因素和特定管理策略结果的数据很少。在本研究中，280 例接受 RIC HCT 的淋巴瘤患者共发生 101 例复发，并对其进行了评估。疾病包括侵袭性非霍奇金淋巴瘤（NHL）（n = 42）、惰性 NHL（n = 33）和霍奇金淋巴瘤（HL）（n = 26）。复发中位时间为 90 天（范围，3-1275 天），56 例（55%）患者在复发时存在移植物抗宿主病。复发后的干预措施包括无治疗（n = 14）、单独停用免疫抑制剂（n = 11）、放化疗（n = 60）和供体淋巴细胞输注/二次 HCT（n = 16）。复发后 3 年的总生存率（OS）为 33%（95%置信区间 [CI]，23%-44%），复发后 5 年的总生存率为 23%（95% CI，13%-34%）。侵袭性 NHL（与惰性疾病相比；风险比，2.29；P =.008）和 HCT 后 1 个月内复发（与 >6 个月相比；风险比，3.17；P =.004）均与死亡率增加相关。复发后侵袭性 NHL 的估计 3 年 OS 为 16%（95% CI，5%-32%），复发后惰性 NHL 为 40%（95% CI，19%-61%），复发后 HL 为 47%（95% CI，29%-64%）。HCT 后 1 个月内复发的患者 1 年生存率为 24%，而 1-3 个月、3-6 个月和 >6 个月复发的患者 1 年生存率分别为 52%、74%和 77%。我们得出结论，尽管 RIC HCT 后淋巴瘤复发，但一些患者可能会获得长期生存，惰性 NHL、HL 或晚期复发的患者的复发后结局更好。
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