Department of Hematology, Xijing Hospital, Fourth Military Medical University, Shaanxi Province, Xi'an, China.
Cell Transplant. 2020 Jan-Dec;29:963689720975397. doi: 10.1177/0963689720975397.
This study aimed to compare the efficacy of allogeneic stem cell transplantation (allo-SCT) versus autologous SCT (auto-SCT) in patients with relapsed or refractory B-cell non-Hodgkin lymphoma (B-NHL). Medline, CENTRAL, and EMBASE databases through December 31, 2019 were searched. The primary endpoints were overall survival (OS) and progression-free survival (PFS) rates. The secondary outcomes include transplant-related mortality (TRM), event-free survival, relapse/or progression, and nonrelapse mortality (NRM). The 18 retrospective studies enrolled 8,058 B-NHL patients (allo-SCT = 1,204; auto-SCT = 6,854). The OS was significantly higher in patients receiving auto-SCT than allo-SCT (pooled odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.29 to 2.22, < 0.001), but no significant difference was found in PFS (pooled OR: 0.98, 95% CI: 0.69 to 1.38, = 0.891). Auto-SCT patients also had lower TRM and NRM (TRM: OR = 0.23, < 0.001; NRM: OR = 0.16, < 0.001), but higher relapse or progression rate (OR = 2.37, < 0.001) than allo-SCT patients. Subgroup analysis performed for different grades and subtypes of B-NHL showed higher OS in auto-SCT patients with high-grade B-NHL and diffused large B-cell lymphoma (DLBCL). There was, nevertheless, higher PFS in allo-SCT patients with low-grade B-NHL and follicular lymphoma (FL), and lower PFS in allo-SCT patients with DLBCL than their auto-SCT counterparts. In conclusion, the meta-analysis demonstrated that relapsed or refractory B-NHL patients who received auto-SCT have improved OS than those treated with allo-SCT, especially among those with DLBCL, but lower PFS among those with FL. However, the study is limited by a lack of randomized trials, patients' heterogeneity, and possible selection bias.
本研究旨在比较异基因造血干细胞移植（allo-SCT）与自体造血干细胞移植（auto-SCT）在复发/难治性 B 细胞非霍奇金淋巴瘤（B-NHL）患者中的疗效。通过检索 Medline、CENTRAL 和 EMBASE 数据库，截至 2019 年 12 月 31 日，纳入了 18 项回顾性研究，共纳入了 8058 例 B-NHL 患者（allo-SCT=1204 例，auto-SCT=6854 例）。结果显示，接受 auto-SCT 的患者的总生存（OS）率显著高于 allo-SCT 组（汇总优势比[OR]：1.69，95%置信区间[CI]：1.29 至 2.22，<0.001），但无进展生存（PFS）率无显著差异（汇总 OR：0.98，95%CI：0.69 至 1.38，=0.891）。与 allo-SCT 组相比，auto-SCT 组患者的移植相关死亡率（TRM）和非复发死亡率（NRM）更低（TRM：OR=0.23，<0.001；NRM：OR=0.16，<0.001），但复发或进展率更高（OR=2.37，<0.001）。对不同分级和亚型的 B-NHL 进行亚组分析发现，auto-SCT 组的高级别 B-NHL 和弥漫性大 B 细胞淋巴瘤（DLBCL）患者 OS 更高。然而，allo-SCT 组的低级别 B-NHL 和滤泡性淋巴瘤（FL）患者的 PFS 更高，DLBCL 患者的 PFS 更低。总之，该 meta 分析表明，与 allo-SCT 相比，接受 auto-SCT 的复发/难治性 B-NHL 患者的 OS 得到改善，特别是在 DLBCL 患者中，但在 FL 患者中 PFS 更低。然而，由于缺乏随机试验、患者异质性和可能的选择偏倚，该研究存在一定的局限性。
