Department of Immunology, Genetics, and Pathology, Clinical and Experimental Oncology, Uppsala University, Uppsala Akademiska Hospital, Uppsala, Sweden.
Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Blood Adv. 2021 Mar 23;5(6):1638-1647. doi: 10.1182/bloodadvances.2020003645.
It is unknown how many mantle cell lymphoma (MCL) patients undergo consolidation with autologous hematopoietic cell transplantation (AHCT), and the reasons governing the decision, are also unknown. The prognostic impact of omitting AHCT is also understudied. We identified all MCL patients diagnosed from 2000 to 2014, aged 18 to 65 years, in the Swedish Lymphoma Register. Odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression models were used to compare the likelihood of AHCT within 18 months of diagnosis. All-cause mortality was compared between patients treated with/without AHCT using hazard ratios (HRs) and 95% CIs estimated from Cox regression models. Probabilities of being in each of the following states: alive without AHCT, alive with AHCT, dead before AHCT, and dead after AHCT, were estimated over time from an illness-death model. Among 369 patients, 148 (40%) were not treated with AHCT within 18 months. Compared with married patients, never married and divorced patients had lower likelihood of undergoing AHCT, as had patients with lower educational level, and comorbid patients. Receiving AHCT was associated with reduced all-cause mortality (HR = 0.58, 95% CI: 0.40-0.85). Transplantation-related mortality was low (2%). MCL patients not receiving an AHCT had an increased mortality rate, and furthermore, an undue concern about performing an AHCT in certain societal groups was seen. Improvements in supportive functions potentially increasing the likelihood of tolerating an AHCT and introduction of more tolerable treatments for these groups are needed.
目前尚不清楚有多少套细胞淋巴瘤（MCL）患者接受自体造血细胞移植（AHCT）巩固治疗，以及决定这一治疗方案的原因。此外，AHCT 治疗的省略对预后的影响也尚未得到充分研究。我们在瑞典淋巴瘤登记处确定了所有在 2000 年至 2014 年期间诊断为年龄在 18 至 65 岁之间的 MCL 患者。使用逻辑回归模型中的比值比（OR）和 95%置信区间（CI）来比较诊断后 18 个月内接受 AHCT 的可能性。使用 Cox 回归模型估计的风险比（HR）和 95%CI 来比较接受和未接受 AHCT 治疗的患者的全因死亡率。使用疾病死亡模型，估计每个患者在以下状态中的概率：未接受 AHCT 治疗时存活、接受 AHCT 治疗时存活、接受 AHCT 治疗前死亡、接受 AHCT 治疗后死亡。在 369 名患者中，有 148 名（40%）在 18 个月内未接受 AHCT 治疗。与已婚患者相比，未婚和离婚患者接受 AHCT 的可能性较低，受教育程度较低和合并症患者也较低。接受 AHCT 与降低全因死亡率相关（HR = 0.58，95%CI：0.40-0.85）。移植相关死亡率较低（2%）。未接受 AHCT 的 MCL 患者死亡率较高，并且在某些社会群体中存在对进行 AHCT 的过度担忧。需要提高支持功能，增加耐受 AHCT 的可能性，并为这些群体引入更耐受的治疗方法。
