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异基因造血干细胞移植治疗复发难治性霍奇金淋巴瘤:单中心真实世界经验。

Allogeneic Stem Cell Transplantation for Relapsed and Refractory Hodgkin Lymphoma: Real World Experience of a Single Center.

机构信息

Department of Hematology and Bone Marrow Transplantation, Medical School of Silesia, Silesian Medical University, Katowice, Poland.

出版信息

Pathol Oncol Res. 2021 Jul 27;27:1609867. doi: 10.3389/pore.2021.1609867. eCollection 2021.

Abstract

Refractory and relapsed Hodgkin lymphoma (R/R HL) is associated with poor prognosis, and allogeneic stem cell transplantation (allo-SCT) remains the only potentially curative approach. The aim of the study was to evaluate the feasibility of allotransplantation in R/R HL setting. Overall, 24 patients (17 men and 7 women) at a median age of 27 years (range 18-44) underwent allo-SCT between 2002 and 2020. Nineteen patients received prior autologous stem cell transplantation (ASCT1) whereas eight patients received second ASCT (ASCT2) after failure of ASCT1. Six patients received only brentuximab vedotin (BV; = 4) or BV followed by checkpoint inhibitors (CPI; = 2) before entering allo-SCT. Median time from ASCT1 to allo-SCT was 17.1 months. Fifteen patients received grafts from unrelated donors. Peripheral blood was a source of stem cells for 16 patients. Reduced-intensity conditioning was used for all patients. Disease status at transplant entry was as follows: complete remission (CR; = 4), partial response (PR; = 10), and stable disease (SD; = 10). Acute and chronic graft-versus-host disease (GVHD) developed in 13 (54%) and 4 (16%) patients, respectively. Median follow-up for the entire cohort was 13.3 months. At the last follow-up, 17 (71%) patients died. The main causes of death were disease progression ( = 10), infectious complications ( = 6), and steroid-resistant GVHD ( = 1). Non-relapse mortality at 12 months was 25%. At the last follow-up, seven patients were alive; six patients were in CR, and one had PR. The 2-year overall survival (OS) was 40%. Chemosensitive disease at transplant was associated with better outcome. Allo-SCT allows for long-term survival in refractory and relapsed HL.

摘要

难治性和复发性霍奇金淋巴瘤(R/R HL)预后差,异基因造血干细胞移植(allo-SCT)仍是唯一潜在的治愈方法。本研究旨在评估 allo-SCT 在 R/R HL 患者中的可行性。 2002 年至 2020 年间,共有 24 例中位年龄为 27 岁(18-44 岁)的患者接受 allo-SCT。19 例患者在接受 allo-SCT 前接受了自体造血干细胞移植(ASCT1),8 例患者在 ASCT1 失败后接受了第二次 ASCT(ASCT2)。6 例患者在进入 allo-SCT 前仅接受了 Brentuximab Vedotin(BV;4 例)或 BV 联合检查点抑制剂(CPI;2 例)治疗。从 ASCT1 到 allo-SCT 的中位时间为 17.1 个月。15 例患者接受了无关供者的移植。16 例患者的干细胞来源于外周血。所有患者均接受了减低强度预处理。移植时疾病状态如下:完全缓解(CR;4 例)、部分缓解(PR;10 例)和疾病稳定(SD;10 例)。13 例(54%)和 4 例(16%)患者分别发生急性和慢性移植物抗宿主病(GVHD)。整个队列的中位随访时间为 13.3 个月。末次随访时,17 例(71%)患者死亡。死亡的主要原因是疾病进展(10 例)、感染并发症(6 例)和激素耐药性 GVHD(1 例)。12 个月非复发死亡率为 25%。末次随访时,7 例患者存活;6 例患者处于 CR,1 例患者处于 PR。2 年总生存率(OS)为 40%。移植时疾病对化疗敏感与更好的结果相关。allo-SCT 可使难治性和复发性 HL 患者获得长期生存。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27c7/8354297/c1c98ab9adce/pore-27-1609867-g001.jpg

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