Department of Internal Medicine, Rochester General Hospital, Rochester, NY 14621, USA.
Department of Internal Medicine, Unity Hospital - Rochester Regional Health, Rochester, NY 14626, USA.
Exp Oncol. 2022 Nov;44(3):190-197. doi: 10.32471/exp-oncology.2312-8852.vol-44-no-3.18599.
Burkitt and Burkitt like lymphoma (BL/BLL) are highly proliferative germinal or post-germinal B cell tumors. Few studies have evaluated the impact of autologous stem cell transplantation (ASCT) on disease outcomes.
We performed a systematic review to analyze the efficacy of ASCT as frontline consolidation and for treatment of relapsed/refractory cases in adult BL/BLL.
Eligible studies with clear outcome measures on the efficacy of ASCT in adult patients with BL/BLL were identified through systematic search. The overall survival (OS), progression-free survival (PFS), complete response (CR), partial response (PR), and progression/relapse were used to assess the efficacy.
For patients who underwent ASCT in first CR, 5-year PFS and OS ranged between 70-78% and 70-83% respectively. For relapsed/refractory disease, 5-year PFS and OS were 27% and 31%, respectively. Patients undergoing ASCT for chemoresistant disease fared poorly with 3-year OS of 7% vs 37% for chemosensitive disease (p ≤ 0.00001). The overall response rate to ASCT for patients transplanted in first CR ranged between 71% and 93% and was 37% for patients who were transplanted in disease status other than first CR. Disease progression/relapse was observed in 16-29% of the patients transplanted in first CR, and 55% to 60% in relapsed disease.
We found insufficient evidence to support ASCT over chemotherapy alone in the first remission for adult BL/BLL. Evidence supports guidelines recommending ASCT for chemosensitive disease but suggests there is no benefit to ASCT for chemoresistant disease.
伯基特淋巴瘤（BL/BLL）是一种高度增殖的生发中心或生发后 B 细胞肿瘤。很少有研究评估自体造血干细胞移植（ASCT）对疾病结局的影响。
我们进行了一项系统评价，分析 ASCT 作为一线巩固治疗以及治疗成人 BL/BLL 复发/难治性病例的疗效。
通过系统检索，确定了明确评估 ASCT 对成人 BL/BLL 患者疗效的研究。使用总生存期（OS）、无进展生存期（PFS）、完全缓解（CR）、部分缓解（PR）和进展/复发来评估疗效。
在首次 CR 接受 ASCT 的患者中，5 年 PFS 和 OS 分别为 70-78%和 70-83%。对于复发/难治性疾病，5 年 PFS 和 OS 分别为 27%和 31%。对于化疗耐药的患者，3 年 OS 为 7%，而对于化疗敏感的患者为 37%（p ≤ 0.00001）。在首次 CR 接受 ASCT 的患者中，ASCT 的总体缓解率在 71%-93%之间，而在非首次 CR 状态下接受 ASCT 的患者中为 37%。在首次 CR 接受移植的患者中，有 16-29%的患者出现疾病进展/复发，而在复发疾病中，有 55%-60%的患者出现疾病进展/复发。
我们发现没有足够的证据支持 ASCT 优于单独化疗作为成人 BL/BLL 的一线缓解治疗。有证据支持指南推荐 ASCT 用于化疗敏感的疾病，但表明 ASCT 对化疗耐药的疾病没有益处。
