Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Division of Biostatistics, Department of Information Sciences, City of Hope, Duarte, California.
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California; Department of Hematology and Hematopoietic Cell Transplantation, Gehr Family Center for Leukemia Research, City of Hope, Duarte, California.
Biol Blood Marrow Transplant. 2019 Feb;25(2):287-292. doi: 10.1016/j.bbmt.2018.09.009. Epub 2018 Sep 15.
The current standard of care for patients with Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) is high-dose conditioning followed by autologous stem cell transplantation (ASCT). For some patients (ie, those with highest-risk disease, insufficient stem cell numbers after mobilization, or bone marrow involvement) allogeneic hematopoietic cell transplantation (alloHCT) offers the potential for cure. However, the majority of patients undergoing alloHCT receive reduced-intensity conditioning as a preparative regimen, and studies assessing outcomes of patients after alloHCT with myeloablative conditioning are limited. In this retrospective study, we reviewed outcomes of 22 patients with recurrent and refractory NHL who underwent alloHCT with myeloablative BEAM conditioning and received tacrolimus/sirolimus as graft-versus-host disease (GVHD) prophylaxis at City of Hope between 2005 and 2018. With a median follow-up of 2.6 years (range, 1.0 to 11.2 years), the probabilities of 2-year overall survival and event-free survival were 58.3% (95% confidence interval [CI], 35.0% to 75.8%) and 45.5% (95% CI, 24.4% to 64.3%), respectively. The cumulative incidence of grade II to IV acute GVHD was 45.5% (95% CI, 23.8% to 64.9%), with only 1 patient developing grade IV acute GVHD. However, chronic GVHD was seen in 55% of the patients (n = 12). Of the 22 eligible patients, 2 had undergone previous ASCT and 2 had undergone previous alloHCT. Both patients with previous ASCT developed severe regimen-related toxicity. Patients who underwent alloHCT with chemorefractory disease had lower survival rates, with 1-year OS and EFS of 44.4% and 33.0%, respectively. In conclusion, alloHCT with a BEAM preparative regimen and tacrolimus/sirolimus-based GVHD should be considered as an alternative option for patients with highest-risk lymphoma whose outcomes are expectedly poor after ASCT.
对于霍奇金淋巴瘤 (HL) 和非霍奇金淋巴瘤 (NHL) 患者，目前的标准治疗方法是大剂量预处理后自体干细胞移植 (ASCT)。对于某些患者（即患有高危疾病、动员后干细胞数量不足或骨髓受累的患者），异基因造血细胞移植 (alloHCT) 有治愈的可能。然而，大多数接受 alloHCT 的患者接受了减低强度预处理作为预处理方案，并且评估接受清髓性 BEAM 预处理的 alloHCT 后患者结局的研究有限。在这项回顾性研究中，我们回顾了 2005 年至 2018 年期间在希望之城接受清髓性 BEAM 预处理和他克莫司/西罗莫司作为移植物抗宿主病 (GVHD) 预防的 22 例复发性和难治性 NHL 患者接受 alloHCT 的结局。中位随访时间为 2.6 年（范围，1.0 至 11.2 年），2 年总生存率和无事件生存率分别为 58.3%（95%CI，35.0%至 75.8%）和 45.5%（95%CI，24.4%至 64.3%）。Ⅱ至Ⅳ级急性 GVHD 的累积发生率为 45.5%（95%CI，23.8%至 64.9%），仅有 1 例患者发生Ⅳ级急性 GVHD。然而，55%的患者（n=12）出现慢性 GVHD。在 22 名符合条件的患者中，有 2 名曾接受过 ASCT，2 名曾接受过 alloHCT。两名曾接受过 ASCT 的患者均发生严重的治疗相关毒性。接受化疗耐药疾病 alloHCT 的患者生存率较低，1 年 OS 和 EFS 分别为 44.4%和 33.0%。总之，对于 ASCT 后预期生存结局较差的高危淋巴瘤患者，应考虑使用 BEAM 预处理方案和他克莫司/西罗莫司的 alloHCT 作为一种替代选择。
