Chen Yi-Bin, Li Shuli, Fisher David C, Driscoll Jessica, Del Rio Candice, Abramson Jeremy, Armand Philippe, Barnes Jeffrey, Brown Jennifer, Cutler Corey, El-Jawahri Areej, Ho Vincent T, Hochberg Ephraim, McAfee Steven, Takvorian Ronald, Spitzer Thomas R, Antin Joseph H, Soiffer Robert, Jacobsen Eric
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Biol Blood Marrow Transplant. 2015 Sep;21(9):1583-8. doi: 10.1016/j.bbmt.2015.05.016. Epub 2015 May 22.
Many patients with lymphoma relapse after autologous stem cell transplantation (AutoSCT). These patients are often considered for allogeneic stem cell transplantation (AlloSCT) if remission can be achieved. If a tandem approach was organized, some cases of relapse might be prevented. We conducted a phase II trial of tandem AutoSCT followed by reduced-intensity conditioning (RIC) AlloSCT for patients with high-risk lymphoma. High-dose chemotherapy was given with busulfan, cyclophosphamide, and etoposide. AlloSCT was composed of RIC with busulfan/fludarabine and tacrolimus, sirolimus, and methotrexate as graft-versus-host disease (GVHD) prophylaxis. Donors were fully matched related or unrelated donors. AlloSCT was performed any time between 40 days and 6 months after AutoSCT. Forty-two patients were enrolled, and all patients underwent AutoSCT. RIC AlloSCT was performed in 29 patients. In the 29 patients who underwent tandem transplant, median time from AutoSCT to AlloSCT was 96 days (range, 48 to 169). The 6-month cumulative incidence of grades II to IV acute GVHD was 13.8% (90% confidence interval [CI], 5.3% to 26.3%). Cumulative incidence of chronic GVHD at 1 year was 37.9% (90% CI, 23.1% to 52.7%). Nonrelapse mortality at 2 years after AlloSCT was 11.1% (90% CI, 3.5% to 23.6%). At a median follow-up of 30 months (range, 17.1 to 51.5) for the entire group, the 2-year progression-free survival rate was 64% (90% CI, 50% to 75%) and the 2-year overall survival rate was 69% (90% CI, 43% to 85%). For the 29 patients who underwent tandem SCT, the 2-year progression-free survival rate was 72% (90% CI, 55% to 83%) and the 2-year OS rate was 89% (90% CI, 74% to 96%). Tandem AutoSCT-RIC AlloSCT appears to be safe and effective in patients with high-risk lymphoma. Prospective trials using such an approach in specific lymphoma subtypes are warranted.
许多淋巴瘤患者在自体干细胞移植（AutoSCT）后会复发。如果能够实现缓解，这些患者通常会考虑进行异基因干细胞移植（AlloSCT）。如果采用串联移植方案，可能会预防一些复发情况。我们对高危淋巴瘤患者进行了一项II期试验，采用串联AutoSCT序贯减低强度预处理（RIC）AlloSCT。高剂量化疗采用白消安、环磷酰胺和依托泊苷。AlloSCT包括采用白消安/氟达拉滨进行RIC预处理，并使用他克莫司、西罗莫司和甲氨蝶呤预防移植物抗宿主病（GVHD）。供者为全相合的亲属或非亲属供者。AlloSCT在AutoSCT后40天至6个月之间的任何时间进行。42例患者入组，所有患者均接受了AutoSCT。29例患者进行了RIC AlloSCT。在接受串联移植的29例患者中，从AutoSCT到AlloSCT的中位时间为96天（范围48至169天）。II至IV级急性GVHD的6个月累积发生率为13.8%（90%置信区间[CI]，5.3%至26.3%）。1年时慢性GVHD的累积发生率为37.9%（90%CI，23.1%至52.7%）。AlloSCT后2年的非复发死亡率为11.1%（90%CI，3.5%至23.6%）。对整个队列进行中位30个月（范围17.1至51.5个月）的随访，2年无进展生存率为64%（90%CI，50%至75%），2年总生存率为69%（90%CI，43%至85%）。对于接受串联SCT的29例患者，2年无进展生存率为72%（90%CI，55%至83%），2年总生存率为89%（90%CI，74%至96%）。串联AutoSCT-RIC AlloSCT对于高危淋巴瘤患者似乎是安全有效的。有必要针对特定淋巴瘤亚型采用这种方法进行前瞻性试验。
