Anderlini Paolo, Saliba Rima M, Ledesma Celina, Plair Tamera, Alousi Amin M, Hosing Chitra M, Khouri Issa F, Nieto Yago, Popat Uday R, Shpall Elizabeth J, Fanale Michelle A, Hagemeister Frederick B, Oki Yasuhiro, Neelapu Saatva, Romaguera Jorge E, Younes Anas, Champlin Richard E
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
Biol Blood Marrow Transplant. 2016 Jul;22(7):1333-1337. doi: 10.1016/j.bbmt.2016.03.028. Epub 2016 Apr 6.
Forty patients (median age, 31 years; range, 20 to 63) with Hodgkin lymphoma underwent an allogeneic stem cell transplant with the gemcitabine-fludarabine-melphalan reduced-intensity conditioning regimen. Thirty-one patients (77%) had undergone a prior autologous stem cell transplant, with a median time to progression after transplant of 6 months (range, 1 to 68). Disease status at transplant was complete remission/complete remission, undetermined (n = 23; 57%), partial remission (n = 14; 35%), and other (n = 3; 8%). Twenty-six patients (65%) received brentuximab vedotin before allotransplant. The overall complete response rate before allotransplant was 65% in brentuximab-treated patients versus 42% in brentuximab-naive patients (P = .15). At the latest follow-up (October 2015) 31 patients were alive. The median follow-up was 41 months (range, 5 to 87). Transplant-related mortality rate at 3 years was 17%. Pulmonary, skin toxicities, and nausea were seen in 13 (33%), 11 (28%), and 37 (93%) patients, respectively. At 3 years, estimates for overall and progression-free survival were 75% (95% CI, 57% to 86%) and 54% (95% CI, 36% to 70%). Overall incidence for disease progression was 28% (95% CI, 16% to 50%). We believe the gemcitabine-fludarabine-melphalan regimen allows moderate dose intensification with acceptable morbidity and mortality. The inclusion of gemcitabine affected nausea, pulmonary, and likely skin toxicity. Exposure to brentuximab vedotin allowed more patients to reach allogeneic stem cell transplantation in complete remission. With over 50% of patients progression-free at 3 years, allogeneic stem cell transplantation with reduced-intensity conditioning remains an effective and relevant treatment option for Hodgkin lymphoma in the brentuximab vedotin era.
40例霍奇金淋巴瘤患者（中位年龄31岁；范围20至63岁）接受了吉西他滨-氟达拉滨-美法仑减低强度预处理方案的异基因干细胞移植。31例患者（77%）曾接受过自体干细胞移植，移植后疾病进展的中位时间为6个月（范围1至68个月）。移植时的疾病状态为完全缓解/完全缓解，情况未明（n = 23；57%）、部分缓解（n = 14；35%）和其他情况（n = 3；8%）。26例患者（65%）在异基因移植前接受了本妥昔单抗治疗。在接受本妥昔单抗治疗的患者中，异基因移植前的总体完全缓解率为65%，而未接受本妥昔单抗治疗的患者为42%（P = 0.15）。在最近一次随访（2015年10月）时，31例患者存活。中位随访时间为41个月（范围5至87个月）。3年时移植相关死亡率为17%。分别有13例（33%）、11例（28%）和37例（93%）患者出现肺部、皮肤毒性和恶心。3年时，总体生存率和无进展生存率估计分别为75%（95%CI，57%至86%）和54%（95%CI，36%至70%）。疾病进展的总体发生率为28%（95%CI，16%至50%）。我们认为吉西他滨-氟达拉滨-美法仑方案可实现适度的剂量强化，且发病率和死亡率可接受。加入吉西他滨影响了恶心、肺部毒性，可能还有皮肤毒性。使用本妥昔单抗使更多患者在完全缓解状态下接受异基因干细胞移植。3年时超过50%的患者无疾病进展，在本妥昔单抗时代，减低强度预处理的异基因干细胞移植仍然是霍奇金淋巴瘤一种有效且相关的治疗选择。
