Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
Leukemia. 2013 Feb;27(2):362-9. doi: 10.1038/leu.2012.228. Epub 2012 Aug 14.
Chronic lymphocytic leukemia (CLL) remains incurable with chemoimmunotherapy, and allogeneic hematopoietic stem cell transplantation (HSCT) offers the potential for cure. We assessed the outcomes of 108 CLL patients undergoing first allogeneic HSCTs, 76 with reduced-intensity (RIC) and 32 with myeloablative conditioning (MAC) between 1998 and 2009 at Dana-Farber Cancer Institute. With median follow-up of 5.9 years in surviving patients, the 5-year overall survival (OS) for the entire cohort is 63% for RIC regimens and 49% for MAC regimens (P=0.18). The risk of death declined significantly starting in 2004, and we found that 5-year OS for HSCT between 2004 and 2009 was 83% for RIC regimens compared with 47% for MAC regimens (P=0.003). For RIC transplantation, we developed a prognostic model based on predictors of progression-free survival (PFS), specifically remission status, lactate dehydrogenase, comorbidity score and lymphocyte count, and found 5-year PFS to be 83% for Score 0, 63% for Score 1, 24% for Score 2 and 6% for Score ≥3 (P<0.0001). We conclude that RIC HSCT for CLL in the current era is associated with excellent long-term PFS and OS, and, as potentially curative therapy, should be considered early in the disease course of relapsed high-risk CLL patients.
慢性淋巴细胞白血病（CLL）仍然无法通过化疗免疫治疗治愈，而异基因造血干细胞移植（HSCT）提供了治愈的潜力。我们评估了 1998 年至 2009 年在 Dana-Farber 癌症研究所接受首次异基因 HSCT 的 108 例 CLL 患者的结果，其中 76 例采用低强度（RIC）方案，32 例采用清髓性（MAC）方案。在存活患者的中位随访 5.9 年后，整个队列的 5 年总生存率（OS）为 RIC 方案的 63%，MAC 方案的 49%（P=0.18）。自 2004 年开始，死亡风险显著下降，我们发现 2004 年至 2009 年 HSCT 的 5 年 OS 为 RIC 方案的 83%，MAC 方案的 47%（P=0.003）。对于 RIC 移植，我们基于无进展生存（PFS）的预测因素（特别是缓解状态、乳酸脱氢酶、合并症评分和淋巴细胞计数）开发了一个预后模型，发现评分 0 为 5 年 PFS 为 83%，评分 1 为 63%，评分 2 为 24%，评分≥3 为 6%（P<0.0001）。我们的结论是，在当前时代，CLL 的 RIC HSCT 与长期 PFS 和 OS 密切相关，并且作为潜在的治愈性治疗方法，应在复发高风险 CLL 患者的疾病早期考虑。
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