Omazic Brigitta, Remberger Mats, Barkholt Lisbeth, Söderdahl Gunnar, Potácová Zuzana, Wersäll Peter, Ericzon Bo-Göran, Mattsson Jonas, Ringdén Olle
Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet and Karolinska University Hospital, Huddinge, Sweden; Department of Oncology-Pathology, Karolinska Institutet and Karolinska University Hospital, Huddinge, Sweden.
Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet and Karolinska University Hospital, Huddinge, Sweden.
Biol Blood Marrow Transplant. 2016 Apr;22(4):676-681. doi: 10.1016/j.bbmt.2015.12.017. Epub 2015 Dec 29.
We wanted to determine whether allogeneic hematopoietic stem cell transplantation (HSCT) may result in long-term survival in patients with solid cancer. HSCT was performed in 61 patients with solid cancer: metastatic renal carcinoma (n = 22), cholangiocarcinoma (n = 17), colon carcinoma (n = 15), prostate cancer (n = 3), pancreatic adenocarcinoma (n = 3), or breast cancer (n = 1). Liver transplantation was performed for tumor debulking in 18 patients. Median age was 56 years (range, 28 to 77). Donors were either HLA-identical siblings (n = 29) or unrelated (n = 32). Conditioning was nonmyeloablative (n = 23), reduced (n = 36), or myeloablative (n = 2). Graft failure occurred in 13 patients (21%). The cumulative incidence of acute graft-versus-host disease (GVHD) of grades II to IV was 47%, and that of chronic GVHD was 32%. Treatment-related mortality was 21%. At 5 years cancer-related mortality was 63%. Currently, 6 patients are alive, 2 with renal cell carcinoma, 1 with cholangiocarcinoma, and 3 with pancreatic carcinoma. Eight-year survival was 12%. Risk factors for mortality were nonmyeloablative conditioning (HR, 2.95; P < .001), absence of chronic GVHD (HR, 3.57; P < .001), acute GVHD of grades II to IV (HR, 2.90; P = .002), and HLA-identical transplant (HR, 5.00; P = .03). With none of these risk factors, survival at 6 years was 50% (n = 6). Long-term survival can be achieved in some patients with solid cancer after HSCT.
我们想要确定异基因造血干细胞移植（HSCT）是否能使实体癌患者获得长期生存。对61例实体癌患者进行了HSCT：转移性肾癌（n = 22）、胆管癌（n = 17）、结肠癌（n = 15）、前列腺癌（n = 3）、胰腺腺癌（n = 3）或乳腺癌（n = 1）。18例患者因肿瘤减瘤而进行了肝移植。中位年龄为56岁（范围28至77岁）。供者为HLA相合的同胞（n = 29）或无关供者（n = 32）。预处理方案为非清髓性（n = 23）、减低剂量（n = 36）或清髓性（n = 2）。13例患者（21%）发生移植物失败。Ⅱ至Ⅳ级急性移植物抗宿主病（GVHD）的累积发生率为47%，慢性GVHD的累积发生率为32%。治疗相关死亡率为21%。5年时癌症相关死亡率为63%。目前，6例患者存活，2例为肾癌，1例为胆管癌，3例为胰腺癌。8年生存率为12%。死亡的危险因素为非清髓性预处理（HR，2.95；P <.001）、无慢性GVHD（HR，3.57；P <.001）、Ⅱ至Ⅳ级急性GVHD（HR，2.90；P =.002）和HLA相合移植（HR，5.00；P =.03）。无这些危险因素时，6年生存率为50%（n = 6）。部分实体癌患者在HSCT后可实现长期生存。
