Hematology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Hospital Sant Pau, Barcelona, Spain.
Hematology Department, Son Espases University Hospital, Palma de Mallorca, Spain.
Transplant Cell Ther. 2021 Jun;27(6):493.e1-493.e8. doi: 10.1016/j.jtct.2021.03.014. Epub 2021 Mar 15.
Despite advances in understanding the biology of mature T and natural killer (NK)/T cell neoplasia, current therapies, even the most innovative ones, are still far from ensuring its cure. The only treatment to date that has been shown to control aggressive T cell neoplasms in the long term is allogeneic stem cell transplantation (alloSCT). We aim to report the results of alloSCT for advanced mature T and NK/T neoplasias performed in centers from our national GELTAMO/GETH (Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular) over the past 25 years. As a secondary objective, we analyzed the results of alloSCT from haploidentical donors. We performed a retrospective analysis of all patients who received an alloSCT in Spanish centers (n = 201) from September 1995 to August 2018. The 2-year overall survival (OS) and disease-free survival (DFS) were 65.5% and 58.2%, respectively. The univariate for OS and DFS showed statistically different hazard ratios for conditioning intensity, response pre-alloSCT, comorbidity index, donor/receptor cytomegalovirus status and Eastern Cooperative Oncology Group (ECOG) pre-alloSCT, but only a better ECOG pre-alloSCT remained significant in the multivariate analysis. There was an increased incidence of relapse in those patients who did not develop chronic graft-versus-host disease (GVHD) and an increased risk of death in those developing moderate to severe acute GVHD. The 1-year nonrelapse mortality was 21.9% and was mainly due to GVHD (30%) and bacterial infections (17%). When comparing unrelated donors with haploidentical donors, we found similar results in terms of OS and DFS. There was, however, a reduction of acute GVHD in the haploidentical group (P = .04) and trend to a reduction of chronic GVHD. In conclusion, alloSCT is the only curative option for most aggressive T cell neoplasias. Haploidentical donors offer similar results to related donors in terms of survival with a reduction of acute GVHD.
尽管在理解成熟 T 细胞和自然杀伤（NK）/T 细胞肿瘤的生物学方面取得了进展，但目前的治疗方法，即使是最具创新性的方法，仍远不能确保其治愈。迄今为止，唯一被证明能够长期控制侵袭性 T 细胞肿瘤的治疗方法是异基因造血干细胞移植（alloSCT）。我们旨在报告过去 25 年来，来自我们的国家 GELTAMO/GETH（Grupo Español de Linfoma y Trasplante de Médula Ósea/Grupo Español de Trasplante Hematopoyético y Terapia Celular）的中心进行的晚期成熟 T 细胞和 NK/T 细胞肿瘤 alloSCT 的结果。作为次要目标，我们分析了来自半相合供者的 alloSCT 的结果。我们对 1995 年 9 月至 2018 年 8 月期间在西班牙中心接受 alloSCT 的所有患者进行了回顾性分析（n=201）。2 年总生存率（OS）和无病生存率（DFS）分别为 65.5%和 58.2%。单因素分析显示，预处理 OS 和 DFS 的危险比在预处理强度、预处理反应、合并症指数、供体/受体巨细胞病毒状态和东部合作肿瘤组（ECOG）有统计学差异，但在多因素分析中仅 ECOG 预处理更好具有显著意义。未发生慢性移植物抗宿主病（GVHD）的患者复发率增加，发生中重度急性 GVHD 的患者死亡风险增加。1 年非复发死亡率为 21.9%，主要归因于 GVHD（30%）和细菌感染（17%）。在比较无关供体与半相合供体时，我们发现 OS 和 DFS 方面的结果相似。然而，半相合组的急性 GVHD 发生率降低（P=0.04），慢性 GVHD 发生率有降低趋势。总之，alloSCT 是大多数侵袭性 T 细胞肿瘤的唯一治愈方法。与相关供者相比，半相合供者在生存方面具有相似的结果，且急性 GVHD 发生率降低。
