Division of Lymphoma-Myeloma, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Institute for Translational Research and Molecular Imaging, Catholic Institutes of Medical Science, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Laboratory of Immune Regulation, Convergent Research Consortium for Immunologic Disease, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Clin Lymphoma Myeloma Leuk. 2019 Jun;19(6):345-355.e7. doi: 10.1016/j.clml.2019.03.023. Epub 2019 Mar 30.
Allogeneic hematopoietic stem cell transplant with reduced-intensity conditioning is an effective therapeutic option for patients with refractory or relapsed aggressive non-Hodgkin lymphoma (NHL).
We retrospectively evaluated survival outcomes and the efficacy of our fludarabine/melphalan/total body irradiation (TBI) (FMT) regimen. A total of 89 patients had received the FMT regimen from 2007 to 2017.
The majority of patients (n = 81; 91%) belonged to the histologic subtype of aggressive NHL. The estimated 3-year overall survival and disease-free survival for the entire cohort during a median follow-up of 31 months were 47.1% (95% confidence interval, 36%-57%) and 45.4% (95% confidence interval, 35%-56%), respectively. The cumulative incidence rates of relapse and non-relapse mortality at 3 years were 33.1% and 13.8%, respectively. In analyses of risk factors affecting survival outcomes, chemosensitive disease status at transplant (hazard ratio [HR], 2.45; P = .010), delayed relapse after first-line chemotherapy (HR, 2.101; P = .009), no grade III to IV acute graft-versus-host disease (HR, 11.212; P < .001), and mild chronic graft-versus-host disease (HR, 0.448; P = .016) were independent significant predictors of favorable overall survival. Also, similar parameters were related to favorable disease-free survival. All non-hematologic toxicities occurred within 50 days after allogeneic hematopoietic stem cell transplant, and most of the adverse events were tolerable and manageable with a < 30% incidence.
Our FMT regimen shows favorable transplant outcomes with relatively low-risk toxicities, so it may be a promising strategy for patients with relapsed or refractory aggressive NHL.
异基因造血干细胞移植联合强度降低的预处理是治疗难治性或复发性侵袭性非霍奇金淋巴瘤（NHL）患者的有效治疗选择。
我们回顾性评估了生存结果和我们的氟达拉滨/马法兰/全身照射（TBI）（FMT）方案的疗效。共有 89 名患者于 2007 年至 2017 年接受了 FMT 方案治疗。
大多数患者（n=81；91%）属于侵袭性 NHL 的组织学亚型。在中位随访 31 个月期间，整个队列的 3 年总生存率和无病生存率分别为 47.1%（95%置信区间，36%-57%）和 45.4%（95%置信区间，35%-56%）。3 年内复发和非复发死亡率的累积发生率分别为 33.1%和 13.8%。在影响生存结果的危险因素分析中，移植时化疗敏感的疾病状态（风险比[HR]，2.45；P=0.010）、一线化疗后延迟复发（HR，2.101；P=0.009）、无 3 级至 4 级急性移植物抗宿主病（HR，11.212；P<0.001）和轻度慢性移植物抗宿主病（HR，0.448；P=0.016）是总生存的独立显著预测因素。同样，类似的参数与无病生存相关。所有非血液学毒性反应均发生在异基因造血干细胞移植后 50 天内，大多数不良事件可耐受且易于管理，发生率<30%。
我们的 FMT 方案显示出良好的移植结果和相对较低的毒性风险，因此可能是复发性或难治性侵袭性 NHL 患者的一种有前途的治疗策略。
