Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences, New Delhi, India.
Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
JCO Glob Oncol. 2022 May;8:e2100383. doi: 10.1200/GO.21.00383.
Published experience with autologous stem-cell transplantation (ASCT) in non-Hodgkin lymphoma (NHL) from the Indian subcontinent is extremely limited. Here, we describe the activity and outcomes of this treatment modality at a large tertiary care center in India.
We retrospectively analyzed adult patients with NHL who were eligible for ASCT and autografted between January 1, 2002, and December 15, 2020, at our transplant unit. Toxicities, complications, and long-term outcomes were compared between patients who underwent transplant during 2002-2012 (group A) and 2013-2020 (group B).
Overall, 80 patients (group A, n = 37; group B, n = 43) underwent ASCT using peripheral blood stem cells. At a median follow-up of 57.6 months, the 5-year event-free survival (EFS) and overall survival (OS) were 43.5% and 47.6%, respectively, for all patients. More recently (group B), patients had reduced 100-day transplant-related mortality (2.3% 21.6%, < .01), improved 3-year EFS (52.9% 37.3%, = .04), and superior OS (at 3-year; 63.4% 43.2%, = .02). Patients in group B also tolerated the procedure better, with improved resource utilization. In multivariate analysis, an International Prognostic Index (IPI) ≥ 3 at diagnosis adversely affected EFS (hazard ratio [HR] = 2.82, = .009) and OS (HR = 2.84, = .01) after ASCT. Low pretransplant serum albumin levels were associated with inferior EFS (HR = 2.68, = .02) and transplant-related mortality (odds ratio = 10.80, = .02) after ASCT.
It is feasible to achieve comparable short- and long-term outcomes in patients with NHL undergoing ASCT in a resource-poor country with improved supportive care and expertise of the transplant team and center.
在印度次大陆，关于非霍奇金淋巴瘤（NHL）患者自体干细胞移植（ASCT）的已发表经验极为有限。在此，我们描述了在印度一家大型三级护理中心进行这种治疗方式的疗效和结果。
我们回顾性分析了于 2002 年 1 月 1 日至 2020 年 12 月 15 日期间在我们移植科进行 ASCT 并适合自体移植的 NHL 成年患者。比较了在 2002-2012 年（A 组，n = 37）和 2013-2020 年（B 组，n = 43）进行移植的患者之间的毒性、并发症和长期结果。
总体而言，80 例患者（A 组，n = 37；B 组，n = 43）接受了外周血干细胞 ASCT。在中位随访 57.6 个月时，所有患者的 5 年无事件生存率（EFS）和总生存率（OS）分别为 43.5%和 47.6%。最近（B 组），100 天移植相关死亡率降低（2.3%比 21.6%，<.01），3 年 EFS 改善（52.9%比 37.3%，<.04），OS 更优（3 年时为 63.4%比 43.2%，<.02）。B 组患者对该治疗的耐受性更好，资源利用率也有所提高。多变量分析显示，诊断时国际预后指数（IPI）≥3 对 ASCT 后 EFS（风险比[HR] = 2.82，<.009）和 OS（HR = 2.84，<.01）产生不良影响。移植前低血清白蛋白水平与 EFS 较差（HR = 2.68，<.02）和移植相关死亡率增加（比值比 = 10.80，<.02）相关。
在资源匮乏的国家，通过改善支持性护理和移植团队及中心的专业知识，进行 ASCT 的 NHL 患者可实现短期和长期疗效的可比结果。
