van Gelder M, van Oers M H, Alemayehu W G, Abrahamse-Testroote M C J, Cornelissen J J, Chamuleau M E, Zachée P, Hoogendoorn M, Nijland M, Petersen E J, Beeker A, Timmers G-J, Verdonck L, Westerman M, de Weerdt O, Kater A P
Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Hematology and Lymphoma and Myeloma Center, Academic Medical Center, Amsterdam, The Netherlands.
Bone Marrow Transplant. 2016 Jun;51(6):799-806. doi: 10.1038/bmt.2016.9. Epub 2016 Feb 15.
Allogeneic stem cell transplantation (alloSCT) remains the only curative option for CLL patients. Whereas active disease at the time of alloSCT predicts poor outcome, no standard remission-induction regimen exists. We prospectively assessed outcome after cisplatin-containing immune-chemotherapy (R-DHAP) followed by alloSCT in 46 patients (median age 58 years) fulfilling modified European Society for Blood and Marrow Transplantation (EBMT) CLL Transplant Consensus criteria being refractory to or relapsed (R/R) <1 year after fludarabine or <2 years after fludarabine-based immunochemotherapy or R/R with del(17p). Twenty-nine patients received ⩾3 cycles of R-DHAP and sixteen <3 cycles (4 because of disease progression, 8 for toxicity and 4 toxic deaths). Overall rate of response to R-DHAP was 58%, 31 (67%) proceeded to alloSCT after conditioning with fludarabine and 2 Gy TBI. Twenty (65%) remained free from progression at 2 years after alloSCT, including 17 without minimal residual disease. Intention-to-treat 2-year PFS and overall survival of the 46 patients were 42 and 51% (35.5 months median follow-up); del(17p) or fludarabine refractoriness had no impact. R-DHAP followed by alloSCT is a reasonable treatment to be considered for high-risk CLL patients without access or resistance to targeted therapies.
异基因干细胞移植（alloSCT）仍然是慢性淋巴细胞白血病（CLL）患者唯一的治愈选择。尽管alloSCT时的活动性疾病预示着预后不良，但目前尚无标准的缓解诱导方案。我们前瞻性评估了46例（中位年龄58岁）符合修改后的欧洲血液和骨髓移植学会（EBMT）CLL移植共识标准（对氟达拉滨难治或复发（R/R）<1年或基于氟达拉滨的免疫化疗后<2年或伴有del(17p)的R/R）的患者在接受含顺铂的免疫化疗（R-DHAP）后进行alloSCT的结局。29例患者接受了⩾3个周期的R-DHAP，16例接受了<3个周期（4例因疾病进展，8例因毒性反应，4例因毒性死亡）。R-DHAP的总体缓解率为58%，31例（67%）在接受氟达拉滨和2 Gy全身照射预处理后进行了alloSCT。20例（65%）在alloSCT后2年无疾病进展，其中17例无微小残留病。46例患者的意向性治疗2年无进展生存率（PFS）和总生存率分别为42%和51%（中位随访35.5个月）；del(17p)或氟达拉滨难治性对此无影响。对于无法获得或对靶向治疗耐药的高危CLL患者，R-DHAP后进行alloSCT是一种可考虑的合理治疗方法。
