Hematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France.
Humanitas Clinical and Research Center, IRCCS, Milan, Italy.
Biol Blood Marrow Transplant. 2020 Dec;26(12):2299-2305. doi: 10.1016/j.bbmt.2020.08.014. Epub 2020 Aug 19.
Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a valid option in patients with refractory lymphomas. HLA haploidentical stem cell transplantation (haplo-SCT) expanded the accessibility to allogeneic hematopoietic cell transplantation. The aims of study were to retrospectively assess the toxicity and efficacy of haplo-SCT using nonmyeloablative conditioning in patients with advanced lymphoma. In total, 147 patients with advanced lymphoma at 2 partner institutions were included. Patients received a uniform nonmyeloablative conditioning regimen and graft-versus-host disease (GVHD) prophylaxis. The primary endpoints were progression-free survival (PFS), overall survival (OS), GVHD, nonrelapse mortality, and GVHD, relapse-free survival (GRFS). Median follow-up was 39 months (range, 6 to 114 months). The median age was 46 years (range, 19 to 71 years). Sixty-five percent of patients were in complete remission (CR) at transplantation. Cumulative incidence of grade II to IV acute GVHD was 30% (95% confidence interval [Cl], 23% to 38%). Two-year cumulative incidence of all grades of chronic GVHD was 13% (95% CI, 8% to 20%). Two-year cumulative incidence of disease relapse was 19% (95% CI, 14% to 27%), with a higher incidence in patients not being in CR at allo-HCT (CR versus not CR: 12% versus 33%, P = .006). Two-year PFS, OS, and GRFS were 66% (95% CI, 59-75), 73% (95% CI, 66-81), and 56% (95% CI, 48-65), respectively. Haplo-SCT with post-transplantation cyclophosphamide may be considered a valid option for patients with aggressive lymphoma and deserves further evaluation.
异基因造血干细胞移植(allo-SCT)是难治性淋巴瘤患者的有效选择。HLA 单倍体相合干细胞移植(haplo-SCT)扩大了异基因造血细胞移植的可及性。本研究的目的是回顾性评估在 2 家合作机构的晚期淋巴瘤患者中使用非清髓性预处理方案的 haplo-SCT 的毒性和疗效。共纳入 147 例晚期淋巴瘤患者。患者接受了统一的非清髓性预处理方案和移植物抗宿主病(GVHD)预防。主要终点是无进展生存期(PFS)、总生存期(OS)、GVHD、非复发死亡率和 GVHD、无复发生存期(GRFS)。中位随访时间为 39 个月(范围 6 至 114 个月)。中位年龄为 46 岁(范围 19 至 71 岁)。65%的患者在移植时处于完全缓解(CR)。Ⅱ至Ⅳ级急性 GVHD 的累积发生率为 30%(95%可信区间[CI],23%至 38%)。2 年慢性 GVHD 的所有等级累积发生率为 13%(95% CI,8%至 20%)。2 年疾病复发率为 19%(95% CI,14%至 27%),allo-HCT 时未达到 CR 的患者复发率较高(CR 与未达到 CR:12%与 33%,P=.006)。2 年 PFS、OS 和 GRFS 分别为 66%(95% CI,59%至 75%)、73%(95% CI,66%至 81%)和 56%(95% CI,48%至 65%)。环磷酰胺后移植的 haplo-SCT 可被视为侵袭性淋巴瘤患者的有效选择,值得进一步评估。