异基因造血干细胞移植在NHL治疗中的地位教材.pptVIP

Acomparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphoma John E. Levine, Richard E. Harris, Fausto R. Loberiza Jr, James O. Armitage, Julie M. Vose, Koen Van Besien, Hillard M. Lazarus, and Mary M. Horowitz, on behalf of the Lymphoma Study Writing Committee of the International Bone Marrow Transplant Registry and Autologous Blood and Marrow Transplant Registry Lymphoblastic lymphoma (LBL) is a rare, clinically aggressive neoplasm of the young that frequently involves the bone marrow (BM) and/or central nervous system. Because LBL is similar to acute lymphoblastic leukemia, some centers prefer allogeneic hematopoietic stem cell (SC) transplantation to autologous SC transplantation. We retrospectively analyzed outcomes for patients who underwent autologous (auto, n 128) or HLAidentical sibling (allo, n 76) SC transplantations from 1989 to 1998 and were reported to International Bone Marrow Transplant Registry (IBMTR) or Autologous Blood and Marrow Transplant Registry (ABMTR). Allo stem cell transplant (SCT) recipients had higher treatment- related mortality (TRM) at 6 months (18% versus 3%, P .002), and this disadvantage persisted at 1 and 5 years. Early relapse rates after alloSC transplantation and autoSC transplantation were similar, but significantly lower relapse rates were observed in alloSCT recipients at 1 and 5 years (32% versus 46%, P .05; and 34% versus 56%, P .004, respectively). No differences were noted in lymphoma-free survival rates between alloSC transplantations and autoSC transplantations (5-year rates 36% versus 39%, P .82). AutoSCT recipients had higher overall survival at 6 months (75% versus 59%, P .01), but survival did not significantly differ between the 2 groups at 1 and 5 years (60% versus 49%, P .09; 44% versus 39%, P .47, respectively). Multivariate analyses to account for confounding factors confirmed these results. Independent of SCT type, BM involvement at the time of transplantation an