Heinzelmann F, Bethge W, Beelen D W, Engelhard M, Kröger N, Dreger P, Niederwieser D, Finke J, Bunjes D, Tischer J, Kobbe G, Holler E, Bornhäuser M, Stelljes M, Baurmann H, Müller A, Haubitz I, Schrezenmeier H, Müller C, Ottinger H
Department of Radiation Oncology, University Hospital (UH) of Tübingen, Tubingen, Germany.
Department of Internal Medicine II, UH of Tübingen, Tubingen, Germany.
Bone Marrow Transplant. 2016 May;51(5):654-62. doi: 10.1038/bmt.2015.348. Epub 2016 Feb 8.
Allogeneic hematopoietic cell transplantation (HCT) offers the chance of cure for patients with non-transformed follicular lymphoma (FL), but is associated with the risk of non-relapse mortality (NRM). The aim of this study was to identify subgroups of FL patients who benefit from HCT. The European Society for Blood and Marrow Transplantation (EBMT) Minimum-Essential-A Data of 146 consecutive patients who received HCT for FL between 1998 and 2008 were extracted from the database of the German Registry 'DRST'. Diagnosis of FL was verified by contact with the reference pathologists. Estimated 1-, 2- and 5-year overall survivals (OS) were 67%, 60% and 53%, respectively. Day 100 NRM was 15%. Thirteen out of 33 patients (40%) with treatment-refractory disease (RD) at the time of transplantation survived long term. Univariate statistical analysis suggested limited chronic GvHD, donor age ⩽42 years and TBI-based conditioning in treatment refractory patients to correlate with favorable OS. Independent prognostic factors for OS were treatment-sensitive disease and limited chronic GvHD for the whole cohort, and additionally TBI-based conditioning for the treatment refractory subgroup. In contrast, patient age ⩾55 years had no impact on outcome. Thus, HCT for FL is associated with acceptable NRM, and offers a substantial chance of cure for patients with RD or advanced age. Donors ⩽42 years should be preferred if available.
异基因造血细胞移植（HCT）为非转化型滤泡性淋巴瘤（FL）患者提供了治愈的机会，但与非复发死亡率（NRM）风险相关。本研究的目的是确定从HCT中获益的FL患者亚组。从德国登记处“DRST”的数据库中提取了1998年至2008年间连续146例接受FL-HCT患者的欧洲血液和骨髓移植学会（EBMT）最低基本-A数据。通过与参考病理学家联系核实FL诊断。估计1年、2年和5年总生存率（OS）分别为67%、60%和53%。移植后第100天的NRM为15%。33例移植时患有治疗难治性疾病（RD）的患者中有13例（40%）长期存活。单变量统计分析表明，难治性患者中有限的慢性移植物抗宿主病（GvHD）、供体年龄≤42岁和基于全身照射（TBI）的预处理与良好的OS相关。整个队列中OS的独立预后因素是治疗敏感疾病和有限的慢性GvHD，难治性子组还包括基于TBI的预处理。相比之下，患者年龄≥55岁对结局无影响。因此，FL-HCT的NRM可接受，为RD或高龄患者提供了相当大的治愈机会。如有可能，应优先选择年龄≤42岁的供体。
