自体干细胞移植治疗首次完全缓解或部分缓解的侵袭性非霍奇金淋巴瘤：根据年龄校正国际预后指数对52例患者结局的回顾性分析

Autologous stem cell transplantation for aggressive non-Hodgkin's lymphomas in first complete or partial remission: a retrospective analysis of the outcome of 52 patients according to the age-adjusted International Prognostic Index.

作者信息

Fanin R, Silvestri F, Geromin A, Infanti L, Sperotto A, Cerno M, Stocchi R, Savignano C, Rinaldi C, Damiani D, Baccarani M

机构信息

Department of Medical and Morphological Research, University Hospital, Udine, Italy.

出版信息

Bone Marrow Transplant. 1998 Feb;21(3):263-71. doi: 10.1038/sj.bmt.1701081.

DOI:10.1038/sj.bmt.1701081

PMID:9489649

Abstract

The aim of the study was to retrospectively evaluate the outcome of patients with aggressive non-Hodgkin's lymphoma (NHL), undergoing autologous stem cell transplantation (ASCT) in first complete (CR) or partial (PR) remission, according to the age-adjusted International Prognostic Index (IPI). Fifty-two consecutive patients, aged less than 60 years, with intermediate- or high-grade NHL, and at least one of the following adverse risk factors: bulky disease, B symptoms or Ann Arbor stage III-IV, and at least a PR after CHT (and radiotherapy (RT) on residual mediastinal mass when required), underwent ASCT conditioned with BAVC. Sixty-five percent (33/52) of the patients achieved CR after CHT; 69% (36/52) after CHT + RT; 90% (47/52) after CHT +/- RT + ASCT. One death during conditioning and three major toxic events after ASCT were recorded. Overall survival (OS) is 98% at 37 months (16-88); disease-free survival (DFS) is 100% at 27 months (7-82). Comparing the observed results with those expected if patients were treated only with CHT, the sequential treatment including ASCT conferred an advantage in terms of CR rate of 14, 23 and 54%, respectively, in the low-intermediate (LI), high-intermediate (HI) and high (H)-risk groups, respectively. The 2-year OS advantage is 10, 21, 31 and 63%, respectively, and the 2-year DFS advantage is 12, 26, 38 and 39%, respectively. Even more striking is the 5-year projected advantage in the number of patients alive without disease, even when considering only the low (L) (P < 0.0001) and the LI (P < 0.0001) risk groups. For patients in the higher (HI + H) risk groups, ASCT should be included in the initial plan of treatment as consolidation of first CR or PR, but the differences seen in this study suggest a formal comparison in a randomized study also for patients in the LI risk group.

摘要

本研究旨在根据年龄校正的国际预后指数（IPI），回顾性评估侵袭性非霍奇金淋巴瘤（NHL）患者在首次完全缓解（CR）或部分缓解（PR）时接受自体干细胞移植（ASCT）的疗效。52例年龄小于60岁、患有中高级别NHL且具有以下至少一项不良风险因素的连续患者：大包块病变、B症状或Ann Arbor分期III-IV期，并且在化疗（CHT）后至少达到PR（必要时对残留纵隔肿块进行放疗（RT）），接受了以BAVC为预处理方案的ASCT。65%（33/52）的患者在CHT后达到CR；CHT + RT后为69%（36/52）；CHT +/- RT + ASCT后为90%（47/52）。记录到1例预处理期间死亡和3例ASCT后的严重毒性事件。37个月（16 - 88个月）时总生存率（OS）为98%；27个月（7 - 82个月）时无病生存率（DFS）为100%。将观察结果与仅接受CHT治疗的预期结果进行比较，包括ASCT的序贯治疗在低中危（LI）、高中危（HI）和高危（H）组中的CR率优势分别为14%、23%和54%。2年OS优势分别为10%、21%、31%和63%，2年DFS优势分别为12%、26%、38%和39%。更显著的是，即使仅考虑低危（L）（P < 0.0001）和低中危（LI）（P < 0.0001）组，预计5年无病存活患者数量也有优势。对于高危（HI + H）组患者，ASCT应作为首次CR或PR的巩固治疗纳入初始治疗计划，但本研究中观察到的差异表明，对于LI风险组患者也应在随机研究中进行正式比较。