高剂量化疗和自体干细胞移植用于复发或难治性原发性纵隔B细胞淋巴瘤。
HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS STEM-CELL TRANSPLANT FOR RELAPSED OR REFRACTORY PRIMARY MEDIASTINAL B-CELL LYMPHOMA.
发表日期：2023 Aug 20
作者：
Hanan Alkhaldi, Alec Reinhardt, Melissa Barnett, Suprateek Kundu, Chitra Hosing, Jeremy Ramdial, Neeraj Saini, Samer Srour, Amin Alousi, Partow Kebriaei, Uday Popat, Muzaffar Qazilbash, Richard Champlin, Elizabeth J Shpall, Allison Gulbis, Terri Lynn Shigle, Bouthaina Dabaja, Chelsea Pinnix, Sairah Ahmed, Raphael Steiner, Borje S Andersson, Yago Nieto
来源：
Cellular & Molecular Immunology
摘要：
原发性纵隔大B细胞淋巴瘤（PMBCL）是一种罕见的侵袭性非何杰金淋巴瘤。含利妥昔单抗的化疗免疫疗法±放疗是标准的一线治疗方法。复发或难治（R/R）疾病长期以来一直采用拯救化疗后接受自体干细胞移植（ASCT）的高剂量化疗作为合适患者的治疗方案。我们对我中心2000年1月至2022年8月期间接受HDC/ASCT治疗的所有R/R PMBCL患者进行了回顾性分析。60名患者接受了利妥昔单抗-BEAM（N=37）或利妥昔单抗-吉西他滨/巴曲霉素/甲氨蝶呤（R-GemBuMel）±沃诺斯他的治疗，同时进行了ASCT。46名患者接受了纵隔放疗，无论是作为一线治疗的预-consolidation还是ASCT后治疗。在中位随访时间为6年（范围为0.3-21）时，整个组的5年无进展生存率（PFS）和总生存率（OS）分别为58%和77%，R-BEAM患者分别为51%和65%，而R-vorinostat/GemBuMel患者分别为69%和82%。多变量分析显示，ASCT时PET阴性（风险比[HR]为0.28）和只有1个器官受累（HR为0.33）与PFS改善独立相关。此外，接受R-vorinostat/GemBuMel（HR为0.23）是独立的有利预测指标。总之，HDC/ASCT在R/R PMBCL中是有效的，并且接受R-vorinostat/GemBuMel的患者具有改善的预后。版权所有 © 2023 Elsevier Inc. 发表。
Primary mediastinal large B cell lymphoma (PMBCL) is an uncommon aggressive type of non-Hodgkin lymphoma. Rituximab-containing chemoimmunotherapy ± radiation therapy (RT) is standard first-line treatment. Relapsed or refractory (R/R) disease has long been treated with salvage chemotherapy followed by high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) in appropriate patients. We retrospectively analyzed all patients with R/R PMBCL treated with HDC/ASCT at our center between January 2000 and August 2022. Sixty patients received rituximab-BEAM (N=37) or rituximab-gemcitabine/busulfan/melphalan (R-GemBuMel) ± vorinostat (N=23), with ASCT. Forty-six patients received mediastinal RT, either as prior consolidation of frontline therapy or following ASCT. At median follow-up of 6 years (range, 0.3-21), the 5-year progression-free survival (PFS) and overall survival (OS) rates of the whole group are 58% and 77%, respectively, 51% and 65%, respectively, for R-BEAM patients, and 69% and 82%, respectively, for R-vorinostat/GemBuMel patients. Multivariable analyses showed that negative PET at ASCT [hazard ratio (HR), 0.28)] and involvement of only 1 organ (HR, 0.33) were independently associated with improved PFS. In addition, receiving R-vorinostat/GemBuMel (HR, 0.23) was an independent favorable predictor of OS. In conclusion, HDC/ASCT is effective in R/R PMBCL, with improved outcomes in patients receiving R-vorinostat/GemBuMel.Copyright © 2023. Published by Elsevier Inc.