Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Clin Lymphoma Myeloma Leuk. 2012 Dec;12(6):406-11. doi: 10.1016/j.clml.2012.07.003. Epub 2012 Sep 14.
In this study, we discuss the results of patients with transformed lymphoma (TL) undergoing stem cell transplantation (SCT). Because of the paucity of literature on the treatment of TL, deciding on the optimal evidence-based treatment is a challenge. Herein, our results indicate that patients with early transformation may benefit the most from SCT.
Transformed non-Hodgkin's lymphoma arising from follicular lymphoma (TL) carries a poor prognosis with a median survival time after transformation reported to be approximately 1 year.
Fifty-one consecutive patients with TL received SCT between January 2000 and December 2010 (autologous SCT, n = 44, allogeneic SCT, n = 7).
Thirty-six (70.5%) patients had an early transformation, defined as histologic evidence of transformation at the time of initial diagnosis or transformation within 1 year of follicular lymphoma. Fifteen patients had early stage disease (29%) and 36 (71%) had advanced stage disease on presentation. At the time of analysis, 37 patients were alive with an estimated 5-year overall survival (OS) and event free survival (EFS) of 61.8% and 45%, respectively. OS and EFS were not significantly different between types of transplant procedure. The major cause of transplant failure was disease recurrence, with estimated 2-year relapse rate of 37.4%. Importantly, early transformation was independently associated with improved OS (hazard ratio [HR] 3.29; P = .028) and EFS (HR 2.49; P = .029).
Our results indicate that an aggressive transplant approach should be considered first in patients with TL and emphasize the need to incorporate novel strategies (eg, immunomodulation) early post-SCT to prevent relapses as disease recurrence remains the major cause of failure in heavily pretreated patients.
本研究讨论了接受干细胞移植（SCT）的转化淋巴瘤（TL）患者的结果。由于关于 TL 治疗的文献很少，因此决定最佳的循证治疗是一项挑战。在这里，我们的结果表明，早期转化的患者可能最受益于 SCT。
滤泡性淋巴瘤（TL）转化的非霍奇金淋巴瘤预后不良，据报道转化后的中位生存时间约为 1 年。
51 例连续 TL 患者于 2000 年 1 月至 2010 年 12 月期间接受 SCT（自体 SCT，n=44；异基因 SCT，n=7）。
36 例（70.5%）患者发生早期转化，定义为初始诊断时或滤泡性淋巴瘤后 1 年内出现组织学转化证据。15 例患者处于早期疾病阶段（29%），36 例（71%）患者处于晚期疾病阶段。在分析时，37 例患者存活，估计 5 年总生存率（OS）和无事件生存率（EFS）分别为 61.8%和 45%。移植程序类型之间的 OS 和 EFS 无显著差异。移植失败的主要原因是疾病复发，估计 2 年复发率为 37.4%。重要的是，早期转化与改善的 OS（风险比[HR]3.29；P=0.028）和 EFS（HR2.49；P=0.029）独立相关。
我们的结果表明，应首先考虑在 TL 患者中采用积极的移植方法，并强调需要在 SCT 后早期采用新策略（例如免疫调节），以防止复发，因为疾病复发仍然是重度预处理患者失败的主要原因。
