CELL INTELLIGENCE · 肿瘤细胞治疗研究
肿瘤细胞治疗研究
英文原题：Comparison of Outcomes After Second Allogeneic Hematopoietic Cell Transplantation Versus Donor Lymphocyte Infusion in Allogeneic Hematopoietic Cell Transplant Patients.
Comparison of Outcomes After Second Allogeneic Hematopoietic Cell Transplantation Versus Donor Lymphocyte Infusion in Allogeneic Hematopoietic Cell Transplant Patients.
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当患者再次达到缓解时，针对移植后复发进行的第二次 HCT 可能会改善结局，而 DLI 可保留用于活动性疾病的患者。
异基因造血细胞移植（HCT）对血液病具有潜在治愈性，但可能并发复发或移植失败（GF），对此需进行二次HCT和供者淋巴细胞输注（DLI）。本研究旨在比较这两种干预措施后的结局。
我们回顾性研究了2011年6月至2020年9月期间首次HCT后复发或GF的89例患者，其中50例（56%）接受了第二次HCT，39例（44%）接受了DLI。
干预时的中位年龄为55岁（19-72）。19例患者因复发接受第二次HCT，31例患者因GF接受第二次HCT（11例为原发性GF，20例为继发性GF），25例（50%）患者使用了同一供者。20例患者因复发接受DLI，19例患者因继发性GF接受DLI。DLI的中位次数为2次（范围1-11）。单因素分析显示，因复发接受第二次HCT的2年总生存期（OS）优于因GF接受者（65% vs 44%）（P = .03）。对于DLI患者，GF的2年OS为49%，复发患者为45%（P = .49）。以复发为指征时，第二次HCT相较于DLI显示出边缘性优势（P = .07）。多因素分析显示，整个队列的OS中，供者错配（HR 0.50，95% CI 0.26%-0.94%，P = .03）、干预时KPS（HR 2.10，95% CI 1.14%-3.85%，P = .02）以及从第一次HCT到干预的时间（HR 0.51，95% CI 0.28%-0.93%，P = .03）为显著变量。
Allogeneic hematopoietic cell transplantation (HCT) is potentially curative for hematological disease however can be complicated by relapse or graft failure (GF), for which second-HCT and donor lymphocyte infusions (DLI) are performed. This study aimed to compare outcomes following the two interventions.
We retrospectively investigated 89 patients with relapse or GF after first-HCT, 50 (56%) underwent second HCT and 39 (44%) received (DLI), from June 2011 to September 2020.
Median age at intervention was 55 years (19-72). Second-HCT was performed for relapse in 19 patients and for GF in 31 patients (primary GF in 11 and secondary in 20 patients), same donor was used in 25 (50%) patients. DLI was performed for relapse in 20 and for secondary GF in 19 patients. Median number of DLI administered was 2 (range 1-11). Univariate analysis demonstrated 2 year overall survival (OS) for second-HCT was superior when performed for relapse (65%) compared to GF (44%) (P = .03). For DLI patients, 2 year OS was 49% for GF and 45% for relapse patients (P = .49). For relapse as an indication, second-HCT demonstrated borderline superiority compared to DLI (P = .07). Multivariable analysis demonstrated for OS for the entire cohort demonstrated donor mismatch (HR 0.50, 95% CI 0.26%-0.94%, P = .03), KPS at time of intervention (HR 2.10, 95% CI 1.14%-3.85%, P = .02) and time from first-HCT to intervention (HR 0.51, 95% CI 0.28%-0.93%, P = .03) as significant variables.
Second-HCT may improve outcomes when performed for relapse post-transplant if patients achieve remission again, while DLI may be reserved for patients with active disease.
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