目的:探讨接受异基因造血干细胞移植的骨髓增生异常综合征患者临床预后的相关因素。方法:回顾性分析2009年1月至2014年12月在我院接受异基因造血干细胞移植的45例骨髓增生异常综合征及其转化为急性髓系白血病患者的临床预后,预处理方案...目的:探讨接受异基因造血干细胞移植的骨髓增生异常综合征患者临床预后的相关因素。方法:回顾性分析2009年1月至2014年12月在我院接受异基因造血干细胞移植的45例骨髓增生异常综合征及其转化为急性髓系白血病患者的临床预后,预处理方案选择、供者来源、移植前化疗对预后的影响。结果:中位随访时间54.6(1-72.1)个月,45例患者4年累积生存率及无病生存率分别为77.1%和62.1%。清髓性预处理组、减低剂量预处理组3年累积生存率分别为69%和68.6%(HR=1.0,P=0.984),3年累积复发率分别为17.6%和33.3%(HR=3.389,P=0.162);HLA相合的非亲缘移植、亲缘移植患者100 d a GVHD累积发生率分别为38.6%和37%(HR=1.089,P=0.885),3年累积生存率为72.7%和70%(HR=0.952,P=0.942);26例RAEB-2和t-AM L患者中,未化疗组、化疗后达CR组2年累积生存率为66.7%和58.3%(HR=1.265,P=0.750);2年累积复发率为20.0%和12.5%(HR=0.417,P=0.477)。发生与未发生a GVHD患者1年累积生存率分别为61.1%和84.9%(HR=4.1,P=0.013),发生a GVHD患者较未发生a GVHD患者TRM风险增大(HR=15.0,P=0.011)。结论:减低预处理剂量并未降低MDS移植患者生存率,老年患者可从中获益,HLA相合的非亲缘移植与亲缘移植效果接近,移植前化疗不能延长生存。展开更多
Allogeneic stem cell transplantation (allo-SCT) is a potential cure for patients with malignant lymphoma that is based on the graft-versus-lymphoma (GVL) effect. Myeloablative conditioning allo-SCT is associated with ...Allogeneic stem cell transplantation (allo-SCT) is a potential cure for patients with malignant lymphoma that is based on the graft-versus-lymphoma (GVL) effect. Myeloablative conditioning allo-SCT is associated with high mortality and morbidity, particularly in patients older than 45 years, heavily pretreated patients (prior hematopoietic stem cell transplantation or more than two lines of conventional chemotherapy) or patients affected by other comorbidities. Therefore, conventional allo-SCT is restricted to younger patients (<50 to 55 years) in good physical condition. Over the last decade, allo-SCT with reduced-intensity conditioning (RIC-allo-SCT) has been increasingly used to treat patients with lymphoma. This treatment is associated with lower toxicity and substantial decrease in the incidence of transplant- related mortality, and has the potential to lead to long-term remissions. Therefore, patients who are not suitable to undergo conventional allo-SCT can benefit from the potentially curative GVL effects of allo-SCT. Although RIC-allo-SCT has improved the survival of lymphoma patients, high post-transplant relapse rates or disease progression mainly results in treatment failure. Thus, further improvement is clearly needed. The role and timing of RIC-allo-SCT in the treatment of lymphoma remains unclear. Therefore, more prospective studies should clarify the effectiveness of this method. In this article, we review the recent literature on RIC-allo-SCT as a treatment for major lymphoma subtypes. Areas that require further investigation in the context of clinical trials are also highlighted.展开更多
文摘目的:探讨接受异基因造血干细胞移植的骨髓增生异常综合征患者临床预后的相关因素。方法:回顾性分析2009年1月至2014年12月在我院接受异基因造血干细胞移植的45例骨髓增生异常综合征及其转化为急性髓系白血病患者的临床预后,预处理方案选择、供者来源、移植前化疗对预后的影响。结果:中位随访时间54.6(1-72.1)个月,45例患者4年累积生存率及无病生存率分别为77.1%和62.1%。清髓性预处理组、减低剂量预处理组3年累积生存率分别为69%和68.6%(HR=1.0,P=0.984),3年累积复发率分别为17.6%和33.3%(HR=3.389,P=0.162);HLA相合的非亲缘移植、亲缘移植患者100 d a GVHD累积发生率分别为38.6%和37%(HR=1.089,P=0.885),3年累积生存率为72.7%和70%(HR=0.952,P=0.942);26例RAEB-2和t-AM L患者中,未化疗组、化疗后达CR组2年累积生存率为66.7%和58.3%(HR=1.265,P=0.750);2年累积复发率为20.0%和12.5%(HR=0.417,P=0.477)。发生与未发生a GVHD患者1年累积生存率分别为61.1%和84.9%(HR=4.1,P=0.013),发生a GVHD患者较未发生a GVHD患者TRM风险增大(HR=15.0,P=0.011)。结论:减低预处理剂量并未降低MDS移植患者生存率,老年患者可从中获益,HLA相合的非亲缘移植与亲缘移植效果接近,移植前化疗不能延长生存。
文摘Allogeneic stem cell transplantation (allo-SCT) is a potential cure for patients with malignant lymphoma that is based on the graft-versus-lymphoma (GVL) effect. Myeloablative conditioning allo-SCT is associated with high mortality and morbidity, particularly in patients older than 45 years, heavily pretreated patients (prior hematopoietic stem cell transplantation or more than two lines of conventional chemotherapy) or patients affected by other comorbidities. Therefore, conventional allo-SCT is restricted to younger patients (<50 to 55 years) in good physical condition. Over the last decade, allo-SCT with reduced-intensity conditioning (RIC-allo-SCT) has been increasingly used to treat patients with lymphoma. This treatment is associated with lower toxicity and substantial decrease in the incidence of transplant- related mortality, and has the potential to lead to long-term remissions. Therefore, patients who are not suitable to undergo conventional allo-SCT can benefit from the potentially curative GVL effects of allo-SCT. Although RIC-allo-SCT has improved the survival of lymphoma patients, high post-transplant relapse rates or disease progression mainly results in treatment failure. Thus, further improvement is clearly needed. The role and timing of RIC-allo-SCT in the treatment of lymphoma remains unclear. Therefore, more prospective studies should clarify the effectiveness of this method. In this article, we review the recent literature on RIC-allo-SCT as a treatment for major lymphoma subtypes. Areas that require further investigation in the context of clinical trials are also highlighted.
