异基因造血干细胞移植治疗复发性滤泡淋巴瘤：代表 EBMT 淋巴瘤工作组和 CIBMTR 淋巴瘤委员会的联合分析。
Allogeneic hematopoietic stem cell transplantation for relapsed follicular lymphoma: A combined analysis on behalf of the Lymphoma Working Party of the EBMT and the Lymphoma Committee of the CIBMTR.
机构信息
Hematology Department, Institut Català d'Oncologia-Hospitalet, Barcelona, Spain.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
Cancer. 2018 Apr 15;124(8):1733-1742. doi: 10.1002/cncr.31264. Epub 2018 Feb 9.
BACKGROUND
Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains the only potentially curative treatment option for relapsed follicular lymphoma (FL), yet questions remain about the optimal timing. This study analyzed long-term outcomes and associated factors among recipients of allo-HCT with FL.
METHODS
Patients with relapsed FL who underwent allo-HCT from 2001 to 2011 with a human leukocyte antigen (HLA)-matched donor were included. Outcome analyses for overall survival (OS), progression-free survival (PFS), transplant-related mortality (TRM), and disease relapse/progression were calculated. A multivariate analysis was performed to determine factors associated with outcomes, and a prognostic score for treatment failure was developed in a subset analysis of patients.
RESULTS
In all, 1567 patients with relapsed FL were included; the median follow-up was 55 months. The 5-year probabilities of OS and PFS were 61% and 52%, respectively. The 5-year cumulative incidences of disease progression/relapse and TRM were 29% and 19%, respectively. Chemoresistant disease, older age, heavy pretreatment, poor performance status (PS), and myeloablative protocols were predictors for worse survival. The prognostic score, using age, lines of prior therapy, disease status, and PS, stratified patients into 3 groups-low, intermediate, and high risk-with 5-year PFS rates of 68%, 53%, and 46%, respectively, and 5-year OS rates of 80%, 62%, and 50%, respectively.
CONCLUSIONS
Allo-HCT should be considered for patients with relapsed FL and available HLA-matched donors. Outcomes are better in earlier phases of the disease, and reduced-intensity conditioning should be preferred. The prognostic score presented here can assist in counseling patients and determining the time to proceed to transplantation. Cancer 2018;124:1733-42. © 2018 American Cancer Society.
背景
异基因造血干细胞移植（allo-HCT）仍然是复发性滤泡淋巴瘤（FL）唯一潜在的治愈治疗选择，但对于最佳时机仍存在疑问。本研究分析了接受 allo-HCT 治疗的复发性 FL 患者的长期结果和相关因素。
方法
纳入了 2001 年至 2011 年间接受 HLA 匹配供体 allo-HCT 的复发性 FL 患者。计算了总生存（OS）、无进展生存（PFS）、移植相关死亡率（TRM）和疾病复发/进展的生存分析。进行了多变量分析以确定与结果相关的因素，并在患者亚组分析中开发了治疗失败的预后评分。
结果
共纳入 1567 例复发性 FL 患者；中位随访时间为 55 个月。OS 和 PFS 的 5 年概率分别为 61%和 52%。疾病进展/复发和 TRM 的 5 年累积发生率分别为 29%和 19%。化疗耐药性疾病、年龄较大、预处理量大、表现状态（PS）差和骨髓清除性方案是生存不良的预测因素。使用年龄、既往治疗线数、疾病状态和 PS 的预后评分将患者分为 3 组-低、中、高危-5 年 PFS 率分别为 68%、53%和 46%，5 年 OS 率分别为 80%、62%和 50%。
结论
对于有复发性 FL 和可获得 HLA 匹配供体的患者，应考虑 allo-HCT。疾病早期阶段的结果更好，应优先采用减量化疗。这里提出的预后评分可以帮助患者咨询和确定进行移植的时间。癌症 2018;124:1733-42。© 2018 美国癌症协会。
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