Fujita Naoto, Kobayashi Ryoji, Atsuta Yoshiko, Iwasaki Fuminori, Suzumiya Junji, Sasahara Yoji, Inoue Masami, Koh Katsuyoshi, Hori Tsukasa, Goto Hiroaki, Ichinohe Tatsuo, Hashii Yoshiko, Kato Koji, Suzuki Ritsuro, Mitsui Tetsuo
Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-Machi, Naka-ku, Hiroshima, 730-8619, Japan.
Department of Pediatrics, Sapporo Hokuyu Hospital, Sapporo, Japan.
Int J Hematol. 2019 Apr;109(4):483-490. doi: 10.1007/s12185-019-02608-y. Epub 2019 Jan 30.
We undertook a retrospective study using the national registry data of hematopoietic stem cell transplantation (HSCT) in Japan to investigate the effect of graft source, particularly autologous or allogeneic tissue, on the treatment outcome in patients aged less than 18 years with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Survival analysis was conducted on 31 autologous HSCT (auto-HSCT) and 48 allogeneic HSCT (allo-HSCT) recipients between 1990 and 2013. The 5-year survival rates were significantly lower for allo-HSCT compared to auto-HSCT recipients (32% vs. 55%; P = 0.036). Multivariate analysis of survival rates identified allogeneic graft, Burkitt histology, and lack of response to chemotherapy as poor prognostic factors for survival. The cumulative incidence of treatment-related mortality (TRM) was significantly higher in allo-HSCT compared to auto-HSCT recipients (P = 0.017), explaining the difference in survival rates. In patients with Burkitt lymphoma (BL), overall survival was significantly inferior in the group of patients undergoing HSCT within 12 months from the initial diagnosis (P = 0.039). These data indicate that treatment outcomes for HSCT in children and adolescents with B-NHL were better in autograft recipients, suggesting that greater attention should be paid to the risk of TRM, especially after allografts, for patients with BL.
我们利用日本造血干细胞移植（HSCT）的国家登记数据进行了一项回顾性研究，以调查移植物来源，特别是自体或异体组织，对18岁以下复发或难治性B细胞非霍奇金淋巴瘤（B-NHL）患者治疗结果的影响。对1990年至2013年间的31例自体HSCT（auto-HSCT）受者和48例异体HSCT（allo-HSCT）受者进行了生存分析。与auto-HSCT受者相比，allo-HSCT受者的5年生存率显著更低（32%对55%；P = 0.036）。生存率的多变量分析确定异体移植物、伯基特组织学类型以及对化疗无反应是生存的不良预后因素。与auto-HSCT受者相比，allo-HSCT受者的治疗相关死亡率（TRM）累积发生率显著更高（P = 0.017），这解释了生存率的差异。在伯基特淋巴瘤（BL）患者中，从初始诊断起12个月内接受HSCT治疗的患者组的总生存率显著更低（P = 0.039）。这些数据表明，B-NHL儿童和青少年患者接受HSCT时，自体移植受者的治疗结果更好，这表明对于BL患者，应更加关注TRM风险，尤其是在异体移植后。
