Yun Seongseok, Vincelette Nicole D, Abraham Ivo, Puvvada Soham, Anwer Faiz
Department of Hematology and Oncology, H. Lee Moffitt Cancer Center, Tampa, Fla., USA.
Acta Haematol. 2016;136(4):244-255. doi: 10.1159/000449031. Epub 2016 Nov 2.
Some patients with low-grade lymphoid malignancies develop transformed disease, requiring stem cell transplantation (SCT). SCT outcomes in transformed low-grade lymphoid malignancies may differ from those of nontransformed disease or other aggressive non-Hodgkin lymphomas. We conducted a pooled analysis of the clinical outcomes of allogeneic versus high-dose therapy (HDT) with autologous SCT in adult patients with transformed low-grade lymphoid malignancies.
A PubMed, EMBASE, and Cochrane search yielded 4 comparative studies reporting allogeneic versus HDT with autologous SCT outcomes in adults (age ≥18) with transformed low-grade lymphoid malignancies, including follicular, chronic/small lymphocytic, and marginal zone lymphoma. Risk ratio (RR) and 95% CI were calculated using random-effects models.
Rates for overall survival (OS) were 51.0 versus 69.5% (RR = 1.55, 95% CI 1.19-2.02, p = 0.001), rates of relapse were 37.3 versus 35.3% (RR = 1.04, 95% CI 0.70-1.55, p = 0.84), and rates of transplant-related mortality (TRM) were 33.3 versus 7.2% (RR = 4.52, 95% CI 2.75-7.43, p < 0.00001) for allogeneic versus autologous SCT. Previous rituximab treatment, reduced intensity conditioning regimen prior to SCT, or original pathology had no prognostic impact.
HDT followed by autologous SCT was associated with lower TRM and a better OS, but there was no difference in relapse versus allogeneic SCT. Autologous SCT may be the better therapeutic option, considering the second chance of allogeneic SCT in the case of relapse.
一些低度恶性淋巴瘤患者会发生疾病转化，需要进行干细胞移植（SCT）。转化型低度恶性淋巴瘤的SCT结果可能与未转化疾病或其他侵袭性非霍奇金淋巴瘤不同。我们对成年转化型低度恶性淋巴瘤患者接受异基因SCT与高剂量治疗（HDT）联合自体SCT的临床结果进行了汇总分析。
通过PubMed、EMBASE和Cochrane检索，获得了4项比较研究，报告了成年（年龄≥18岁）转化型低度恶性淋巴瘤（包括滤泡性、慢性/小淋巴细胞性和边缘区淋巴瘤）患者接受异基因SCT与HDT联合自体SCT的结果。采用随机效应模型计算风险比（RR）和95%置信区间（CI）。
异基因SCT与自体SCT的总生存率（OS）分别为51.0%和69.5%（RR = 1.55，95% CI 1.19 - 2.02，p = 0.001），复发率分别为37.3%和35.3%（RR = 1.04，95% CI 0.70 - 1.55，p = 0.84），移植相关死亡率（TRM）分别为33.3%和7.2%（RR = 4.52，95% CI 2.75 - 7.43，p < 0.00001）。既往利妥昔单抗治疗、SCT前降低强度预处理方案或原始病理类型对预后无影响。
HDT联合自体SCT与较低的TRM和较好的OS相关，但与异基因SCT相比复发率无差异。考虑到复发时可进行异基因SCT，自体SCT可能是更好的治疗选择。
