University of Chicago Hospitals, Chicago, USA.
J Clin Oncol. 2013 Sep 1;31(25):3100-9. doi: 10.1200/JCO.2012.46.0188. Epub 2013 Jul 29.
To analyze outcomes of hematopoietic cell transplantation (HCT) in T-cell non-Hodgkin lymphoma.
Outcomes of 241 patients (112 anaplastic large-cell lymphoma, 102 peripheral T-cell lymphoma not otherwise specified, 27 angioimmunoblastic T-cell lymphoma) undergoing autologous HCT (autoHCT; n = 115; median age, 43 years) or allogeneic HCT (alloHCT; n = 126; median age, 38 years) were analyzed. Primary outcomes were nonrelapse mortality (NRM), relapse/progression, progression-free survival (PFS), and overall survival (OS). Patient, disease, and HCT-related variables were analyzed in multivariate Cox proportional hazard models to determine association with outcomes.
AutoHCT recipients were more likely in first complete remission (CR1; 35% v 14%; P = .001) and with chemotherapy-sensitive disease (86% v 60%; P < .001), anaplastic large-cell histology (53% v 40%; P = .04), and two or fewer lines of prior therapy (65% v 44%; P < .001) compared with alloHCT recipients. Three-year PFS and OS of autoHCT recipients beyond CR1 were 42% and 53%, respectively. Among alloHCT recipients who received transplantations beyond CR1, 31% remained progression-free at 3 years, despite being more heavily pretreated and with more refractory disease. NRM was 3.5-fold higher (95% CI, 1.80 to 6.99; P < .001) for alloHCT. In multivariate analysis, chemotherapy sensitivity (hazard ratio [HR], 1.8; 95% CI, 1.16 to 2.87) and two or fewer lines of pretransplantation therapy (HR, 5.02; 95% CI, 2.15 to 11.72) were prognostic of survival.
These data describe the roles of autoHCT and alloHCT in T-cell non-Hodgkin lymphoma and suggest greater effectiveness earlier in the disease course, and limited utility in multiply relapsed disease. Notably, autoHCT at relapse may be a potential option for select patients, particularly those with anaplastic large-cell lymphoma histology.
分析 T 细胞非霍奇金淋巴瘤患者行造血细胞移植（HCT）的治疗结局。
对 241 例患者（112 例间变性大细胞淋巴瘤，102 例非特指外周 T 细胞淋巴瘤，27 例血管免疫母细胞性 T 细胞淋巴瘤）的自体 HCT（autoHCT；n=115；中位年龄 43 岁）或异基因 HCT（alloHCT；n=126；中位年龄 38 岁）治疗结局进行分析。主要结局指标为非复发死亡率（NRM）、复发/进展、无进展生存（PFS）和总生存（OS）。采用多变量 Cox 比例风险模型分析患者、疾病和 HCT 相关变量与结局的相关性。
autoHCT 组患者更易达到完全缓解 1 期（CR1；35%比 14%；P=0.001）和对化疗敏感（86%比 60%；P<0.001），组织学为间变性大细胞淋巴瘤（53%比 40%；P=0.04）和接受 2 线或以下的既往治疗（65%比 44%；P<0.001）。autoHCT 组 CR1 后 3 年的 PFS 和 OS 分别为 42%和 53%。alloHCT 组在 CR1 后接受移植的患者中，尽管预处理强度更高，疾病更具难治性，但仍有 31%在 3 年内无进展。NRM 是 alloHCT 的 3.5 倍（95%CI，1.80 至 6.99；P<0.001）。多变量分析显示，化疗敏感性（风险比[HR]，1.8；95%CI，1.16 至 2.87）和移植前接受 2 线或以下治疗（HR，5.02；95%CI，2.15 至 11.72）是生存的预后因素。
这些数据描述了 autoHCT 和 alloHCT 在 T 细胞非霍奇金淋巴瘤中的作用，并提示在疾病早期更有效，而在多次复发的疾病中效用有限。值得注意的是，autoHCT 在复发时可能是某些患者（特别是间变性大细胞淋巴瘤患者）的一个潜在选择。
