Department of Pediatrics, Yamagata University Hospital, Yamagata, Japan.
Department of Pediatrics, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.
Pediatr Blood Cancer. 2020 Apr;67(4):e28129. doi: 10.1002/pbc.28129. Epub 2019 Dec 26.
Patients with relapsed or refractory lymphoblastic lymphoma (LBL) have a poor prognosis. The efficacy of allogeneic blood stem cell transplantation for treatment of this disease remains unclear in terms of transplantation-related toxicity. Acute and chronic graft-versus-host diseases (GVHD) are both harmful to patients after allogeneic transplantation, but may have some positive effects through a substitute graft-versus-lymphoma effect.
To investigate the effect of GVHD on the survival of patients with refractory LBL, we retrospectively studied the outcomes of 213 patients with LBL who underwent first allogeneic stem cell transplantation before the age of 18 years, between 1990 and 2015 in Japan.
The five-year overall survival (OS) and event-free survival rates after stem cell transplantation were 50.3% (95% confidence interval [CI], 43.2-56.9) and 47.8% (95% CI, 40.8-54.4), respectively. In univariate landmark analyses, the probability of OS was significantly better in patients with aGVHD than in those without (P = 0.002, five-year OS 58.1% vs 39.0%). The probability of OS was also better in patients with cGVHD than in those without (P = 0.036, five-year OS 72.2% vs 54.7%). Multivariate analysis demonstrated that only aGVHD was associated with better OS (hazard ratio, 0.63; 95% CI, 0.42-0.94, P = 0.024). Progression and recurrence statuses at SCT were associated with poor prognosis. The patients with grade II aGVHD showed the best prognosis (five-year OS: 65.6%).
Our results suggest that the occurrence of aGVHD may be associated with better outcomes in patients with relapsed/refractory LBL who undergo allogeneic transplantation.
复发或难治性淋巴母细胞淋巴瘤（LBL）患者预后较差。异体造血干细胞移植治疗该病的疗效尚不清楚，因为其与移植相关的毒性。急性和慢性移植物抗宿主病（GVHD）在异体移植后对患者均有害，但可能通过替代移植物抗淋 巴瘤效应产生一些积极影响。
为了研究 GVHD 对难治性 LBL 患者生存的影响，我们对 1990 年至 2015 年间在日本接受首次异体造血干细胞移植的 213 例 18 岁以下 LBL 患者的结果进行了回顾性研究。
干细胞移植后的 5 年总生存率（OS）和无事件生存率分别为 50.3%（95%可信区间[CI]，43.2-56.9）和 47.8%（95% CI，40.8-54.4）。在单因素 landmark 分析中，有急性 GVHD 的患者的 OS 概率明显优于无急性 GVHD 的患者（P=0.002，5 年 OS 为 58.1% vs 39.0%）。慢性 GVHD 患者的 OS 概率也优于无慢性 GVHD 的患者（P=0.036，5 年 OS 为 72.2% vs 54.7%）。多因素分析表明，只有急性 GVHD 与更好的 OS 相关（风险比，0.63；95% CI，0.42-0.94，P=0.024）。SCT 时的进展和复发状态与预后不良相关。GVHD 为 II 级的患者预后最佳（5 年 OS：65.6%）。
我们的结果表明，在接受异体移植的复发/难治性 LBL 患者中，急性 GVHD 的发生可能与更好的结局相关。
