Cudillo Laura, Cerretti Raffaella, Picardi Alessandra, Mariotti Benedetta, De Angelis Gottardo, Cantonetti Maria, Postorino Massimiliano, Ceresoli Eleonora, De Santis Giovanna, Nasso Daniela, Pisani Francesco, Scala Enrico, Di Piazza Fabio, Lanti Alessandro
Hematology and Stem Cell Transplant Unit, Tor Vergata University, Viale Oxford 81, 00133, Rome, Italy.
Hematology, Regina Elena National Cancer Institute, Rome, Italy.
Ann Hematol. 2018 Jun;97(6):1041-1048. doi: 10.1007/s00277-018-3275-z. Epub 2018 Feb 13.
In our retrospective study, 16 patients affected by advanced cutaneous T cell lymphoma (CTCL) underwent allogeneic hematopoietic stem cell transplantation (HSCT). Two patients (12.5%) were in complete remission (CR), nine (56.3%) in partial remission (PR), and five (31.2%) with active disease. The patients were transplanted from an HLA-identical (n = 7) from a mismatched (n = 1) or haploidentical (n = 1) sibling, from matched unrelated donor (n = 5), or from a single cord blood unit (n = 2). Conditioning regimen was standard myeloablative in 6 patients and at reduced intensity in 10. Seven patients died from non relapse mortality (NRM) and four patients relapsed or progressed, three of them achieved a second CR after donor lymphocyte infusion (DLI) or chemotherapy plus DLI. To date, with a median follow-up of 76 months (range 6-130), nine patients are alive, eight in CR, and one with active disease. Overall survival (OS) and disease-free survival (DFS) at 1 and 10 years are 61% (95% CI 40-91%) and 54% (95% CI 33-86%), 40% (95% CI 22-74%), and 34% (95% CI 16-68%), respectively. The time from diagnosis to transplant seems to influence negatively both OS (log-rank p < 0.04) and DFS (log-rank p < 0.05). Our results confirm on a long follow-up that CTCL appears particularly susceptible to the graft versus lymphoma (GVL) effect, so that allogeneic HSCT represents a possibility of cure for advanced CTCL. The timing of HSCT in the clinical course of disease remains an open issue.
在我们的回顾性研究中，16例晚期皮肤T细胞淋巴瘤（CTCL）患者接受了异基因造血干细胞移植（HSCT）。2例患者（12.5%）完全缓解（CR），9例（56.3%）部分缓解（PR），5例（31.2%）疾病活动。患者的供者来源为 HLA 全相合的同胞（n = 7）、HLA 不相合或半相合的同胞（n = 1）、匹配的无关供者（n = 5）或单个脐血单位（n = 2）。6例患者采用标准清髓性预处理方案，10例采用减低强度预处理方案。7例患者死于非复发死亡率（NRM），4例患者复发或病情进展，其中3例在供者淋巴细胞输注（DLI）或化疗加DLI后再次获得CR。截至目前，中位随访76个月（范围6 - 130个月），9例患者存活，8例处于CR，1例疾病活动。1年和10年的总生存（OS）率和无病生存（DFS）率分别为61%（95%CI 40 - 91%）和54%（95%CI 33 - 86%），40%（95%CI 22 - 74%）和34%（95%CI 16 - 68%）。从诊断到移植的时间似乎对OS（对数秩检验p < 0.04）和DFS（对数秩检验p < 0.05）均有负面影响。我们的结果通过长期随访证实，CTCL似乎对移植物抗淋巴瘤（GVL）效应特别敏感，因此异基因HSCT是晚期CTCL的一种治愈可能。HSCT在疾病临床进程中的时机仍是一个未解决的问题。
