Division of Hematology/Oncology, Department of Medicine, University of Arizona and University of Arizona Cancer Center, Tucson, Arizona, USA.
Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Br J Haematol. 2022 Apr;197(2):212-222. doi: 10.1111/bjh.18052. Epub 2022 Feb 2.
There have been no large studies comparing reduced-intensity/non-myeloablative conditioning (RIC/NMA) to myeloablative conditioning (MAC) regimens in T-cell non-Hodgkin lymphoma (T-NHL) patients undergoing allogeneic transplant (allo-HCT). A total of 803 adults with peripheral T-cell lymphoma, anaplastic large cell lymphoma and angioimmunoblastic T-cell lymphoma (age 18-65 years), undergoing allo-HCT between 2008-2019 and reported to the Center for International Blood and Marrow Transplant Research with either MAC (n = 258) or RIC/NMA regimens (n = 545) were evaluated. There were no significant differences between the two cohorts in terms of patient sex, race and performance scores. Significantly more patients in the RIC/NMA cohort had peripheral blood grafts, haematopoietic cell transplantation-specific comorbidity index (HCT-CI) of ≥3 and chemosensitive disease compared to the MAC cohort. On multivariate analysis, overall survival (OS) was not significantly different in the RIC/NMA cohort compared to the MAC cohort (hazard ratio (HR) = 1.01, 95% confidence interval (CI) = 0.79-1.29; p = 0.95). Similarly, non-relapse mortality (NRM) (HR = 0.85, 95% CI = 0.61-1.19; p = 0.34), risk of progression/relapse (HR = 1.29; 95% CI = 0.98-1.70; p = 0.07) and therapy failure (HR = 1.14; 95% CI = 0.92-1.41, p = 0.23) were not significantly different between the two cohorts. Relative to MAC, RIC/NMA was associated with a significantly lower risk of grade 3-4 acute graft-versus-host disease (HR = 0.67; 95% CI = 0.46-0.99, p = 0.04). Among chemorefractory patients, there was no difference in OS, therapy failure, relapse, or NRM between RIC/NMA and MAC regimens. In conclusion, we found no association between conditioning intensity and outcomes after allo-HCT for T-cell NHL.
在接受同种异体造血干细胞移植 (allo-HCT) 的 T 细胞非霍奇金淋巴瘤 (T-NHL) 患者中，比较减低强度/非清髓性预处理 (RIC/NMA) 与清髓性预处理 (MAC) 方案的大型研究尚未见报道。共纳入了 803 例年龄在 18-65 岁之间的外周 T 细胞淋巴瘤、间变性大细胞淋巴瘤和血管免疫母细胞性 T 细胞淋巴瘤患者，这些患者于 2008 年至 2019 年在国际血液和骨髓移植研究中心接受 allo-HCT，并报告了 MAC（n=258）或 RIC/NMA 方案（n=545）。两组患者在患者性别、种族和表现评分方面无显著差异。与 MAC 组相比，RIC/NMA 组的患者外周血移植物、造血细胞移植特异性合并症指数（HCT-CI）≥3 和化疗敏感疾病的比例显著更高。多变量分析显示，RIC/NMA 组与 MAC 组的总生存率（OS）无显著差异（风险比（HR）=1.01，95%置信区间（CI）=0.79-1.29；p=0.95）。同样，非复发死亡率（NRM）（HR=0.85，95%CI=0.61-1.19；p=0.34）、进展/复发风险（HR=1.29；95%CI=0.98-1.70；p=0.07）和治疗失败（HR=1.14；95%CI=0.92-1.41，p=0.23）在两组间也无显著差异。与 MAC 相比，RIC/NMA 与 3-4 级急性移植物抗宿主病（GVHD）的风险显著降低相关（HR=0.67；95%CI=0.46-0.99，p=0.04）。在化疗耐药患者中，RIC/NMA 与 MAC 方案在 OS、治疗失败、复发或 NRM 方面无差异。总之，我们发现 T 细胞 NHL 患者 allo-HCT 后预处理强度与结局之间无关联。
