Princess Margaret Cancer Centre, Canada.
J Clin Oncol. 2013 Mar 20;31(9):1164-71. doi: 10.1200/JCO.2012.44.0693. Epub 2013 Feb 11.
To determine whether autologous (auto) or allogeneic (allo) stem-cell transplantation (SCT) improves outcome in patients with transformed follicular lymphoma compared with rituximab-containing chemotherapy alone.
This was a multicenter cohort study of patients with follicular lymphoma and subsequent biopsy-proven aggressive histology transformation. Patient, treatment, and outcome data were collected from each transplantation center and combined for analysis. A separate control group was composed of patients with transformation treated with rituximab-containing chemotherapy but not SCT. The primary end point was overall survival (OS) after transformation.
One hundred seventy-two patients were identified: 22 (13%) treated with alloSCT, 97 (56%) with autoSCT, and 53 (31%) with rituximab-containing chemotherapy. Five-year OS after transformation was 46% for patients treated with alloSCT, 65% with autoSCT, and 61% with rituximab-containing chemotherapy (P = .24). Five-year progression-free survival (PFS) after transformation was 46% for those treated with alloSCT, 55% with autoSCT, and 40% with rituximab-containing chemotherapy (P = .12). In multivariate analysis, patients treated with autoSCT had improved OS compared with those who received rituximab-containing chemotherapy (hazard ratio [HR], 0.13; 95% CI, 0.05 to 0.34; P < .001). On the other hand, there was no OS difference between those treated with alloSCT and rituximab-containing chemotherapy (HR, 0.44; 95% CI, 0.16 to 1.24; P = .12). OS and PFS after SCT were similar between those treated with autoSCT and alloSCT. Five-year transplantation-related mortality was 23% for those treated with alloSCT and 5% for autoSCT.
Patients undergoing autoSCT had better outcomes than those treated with rituximab-containing chemotherapy alone. AlloSCT did not improve outcome compared with rituximab-containing chemotherapy and was associated with clinically significant toxicity.
确定与单独含利妥昔单抗的化疗相比，自体（auto）或同种异体（allo）干细胞移植（SCT）是否能改善转化滤泡性淋巴瘤患者的预后。
这是一项多中心队列研究，纳入了滤泡性淋巴瘤患者，随后活检证实为侵袭性组织学转化。从每个移植中心收集患者、治疗和结局数据，并进行合并分析。单独的对照组由接受含利妥昔单抗的化疗但未接受 SCT 治疗的转化患者组成。主要终点是转化后的总生存（OS）。
共确定 172 例患者：alloSCT 治疗 22 例（13%），autoSCT 治疗 97 例（56%），含利妥昔单抗的化疗治疗 53 例（31%）。alloSCT 治疗、autoSCT 治疗和含利妥昔单抗的化疗组的 5 年 OS 分别为 46%、65%和 61%（P=0.24）。alloSCT 治疗、autoSCT 治疗和含利妥昔单抗的化疗组的 5 年无进展生存（PFS）分别为 46%、55%和 40%（P=0.12）。多变量分析显示，与接受含利妥昔单抗的化疗相比，接受 autoSCT 治疗的患者 OS 得到改善（风险比[HR]，0.13；95%CI，0.05 至 0.34；P<0.001）。另一方面，alloSCT 治疗与含利妥昔单抗的化疗之间的 OS 无差异（HR，0.44；95%CI，0.16 至 1.24；P=0.12）。SCT 后 OS 和 PFS 在接受 autoSCT 和 alloSCT 治疗的患者之间相似。alloSCT 治疗者的 5 年移植相关死亡率为 23%，autoSCT 治疗者为 5%。
与单独接受含利妥昔单抗的化疗相比，接受 autoSCT 治疗的患者具有更好的结局。alloSCT 并未改善与含利妥昔单抗的化疗相比的预后，且与临床显著毒性相关。
