1、滤泡性滤泡性(22%)(22%)弥漫大弥漫大B B细胞细胞(31%)(31%)套细胞(6%)外周T细胞(6%)2%其他亚型(9%)复合淋巴瘤(13%)小淋巴细胞(6%)边缘区B细胞MALT型(5%)边缘区B细胞结节型(1%)淋巴浆细胞(1%)同基因移植HLA相合同胞HLA相合非血缘关系供体HLA不完全相合亲属HSC部位骨髓移植外周血移植脐血移植预处理:清髓性移植非清髓移植TRANSPLANTS4,50005001,0001,5002,000Allogeneic(Total N=7,200)Autologous(Total N=10,500)2,5003,0004,0003,500BreastC
2、ancerNHLMultipleMyelomaAMLALLCMLMDS/OtherLeukemiaCLLOtherCancerNeuroblastomaHodgkinDiseaseNon-MalignantDisease7Auto:MM+NHLAllo:AML+ALL+CML+MDS异基因移植优点l移植物抗肿瘤作用，复发率较低缺点l供体来源受限制lGVHD等移植相关并发症较多l年龄范围较窄Schouten HC,Qian W,Kvaloy S,et al.High dose therapy improves progression free survival and survival in r
3、elapsed follicular non-Hodgkins lymphoma(NHL):results from the randomized European CUP trial.J Clin Oncol.In press.Schouten HC,Qian W,Kvaloy S,et al.High dose therapy improves progression free survival and survival in relapsed follicular non-Hodgkins lymphoma(NHL):results from the randomized Europea
4、n CUP trial.J Clin Oncol.In press.van Besien K,Loberiza FR Jr,et al.Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma.Blood 2003;102:3521-9.相合的异基因相合的异基因 净化后自体净化后自体 未净化自体未净化自体van Besien K,Loberiza FR Jr,et al.Comparison of autologous and allogenei
5、c hematopoietic stem cell transplantation for follicular lymphoma.Blood 2003;102:3521-9.近些年，近些年，移植技移植技术逐渐术逐渐进步进步Forrest DL,Thompson K,.Allogeneic hematopoietic stem cell transplantationfor progressive follicular lymphoma.Bone Marrow Transplant 2002;29:973-8.Pavletic Z S,Arrowsmith E R,Bierman P J,et
6、 al.Outcome of allogeneic stem cell transplantation for B cell chronic lymphocytic leukemiaJ.Bone MarrowTransplant,2000,25(7):7179 722.Verdonck L,Dekker A,Lokhorst H,Petersen E,Nieuwenhuis H.Allogeneic versus autologous bone marrow transplantation for refractory and recurrent low-grade non-Hodgkins
7、lymphoma.Blood 1997;90:4201-5.Hosing C,Saliba R M,McLaughlin P,et al.Long3 term results favor allogeneic over autologous hematopoietic stem cell transplantation in patients with refractory or recurrent indolent non 4 Hodgkins lymphomaJ.Ann Oncol,2003,14(5):7375 744.020406080100Probability,%Chemo-sen
8、sitive,1996-99(N=1,711)02613Years45P 0.001Chemo-sensitive,2000-04(N=3,122)Chemo-resistant,1996-99(N=283)Chemo-resistant,2000-04(N=258)pillip T,Gomez F,Guglielm i C,et al.Long2term outcome of relap sed non-Hodgkins L ymphoma(NHL)patients included in the PARMA trial:Incidence of late relap ses,long2te
9、rm toxicity and impact of ther International P rogno stice Index(IP I)atrelap seJ.P roc Am Soc Clin Onco l,1998,17:16a.AJ Peniket An EBMT registry matched study of allogeneic stem cell transplantsfor lymphoma:allogeneic transplantation is associated with a lower relapserate but a higher procedure-re
10、lated mortality rate than autologous Transplantation.Bone Marrow Transplantation(2003)31,66767851%42%AJ Peniket An EBMT registry matched study of allogeneic stem cell transplantsfor lymphoma:allogeneic transplantation is associated with a lower relapserate but a higher procedure-related mortality ra
11、te than autologous Transplantation.Bone Marrow Transplantation(2003)31,66767838%41%37%25%AJ Peniket An EBMT registry matched study of allogeneic stem cell transplants for lymphoma:allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than au
12、tologous Transplantation.Bone Marrow Transplantation(2003)31,667678TRMTRMNorbert Schmitz,Peter Dreger.Allogeneic transplantation in lymphoma:current status。Haematologica 2007;92:1533-1548.020406080100Probability,%Chemo-sensitive,Myeloablative(N=214)02613Years45P=0.011Chemo-sensitive,RIC(N=56)Chemo-r
13、esistant,Myeloablative(N=75)Chemo-resistant,RIC(N=26)RIC=Reduced Intensity Conditioning020406080100Probability,%Auto(N=1,202)02613Years45P 0.001HLA-id sib,RIC(N=111)unrelated,RIC(N=60)HLA-id sib,Myeloablative(N=205)Unrelated,Myeloablative(N=46)Kim SW,Tanimoto TE,Hirabayashi N,Goto S,et al.Myeloablat
14、ive allogeneic hematopoietic stem cell transplantation for non-Hodgkin lymphoma:a nationwide survey in Japan.Blood 2006;108:382-9.36:205-13.42%39%21%Kim SW,Tanimoto TE,Hirabayashi N,Goto S,et al.Myeloablative allogeneic hematopoietic stem cell transplantation for non-Hodgkin lymphoma:a nationwide su
15、rvey in Japan.Blood 2006;108:382-9.36:205-13.Levine J E,Harris R E,Loberiza F R Jr,et al.A comparison of allogeneic and autologous bone marrow transplantation for lymphoblastic lymphomaJ.Blood,2003,101(7):24768 2482.3488.Levine J E,Harris R E,Loberiza F R Jr,et al.A comparison of allogeneic and auto
16、logous bone marrow transplantation for lymphoblastic lymphomaJ.Blood,2003,101(7):24768 2482.3488.Schmitz N,Dreger P,Glass B,Allogeneic transplantation in lymphoma:current status.Haematologica.2007 Nov;92(11):1533-48.Review.E Kusumi1,M Kami2,Reduced-intensity hematopoietic stem-cell transplantation f
17、or malignant lymphoma:a retrospective survey of 112 adult patients in Japan.Bone Marrow Transplantation(2005)36,205213.56%75%44%75%22%22%34%5%Sorror ML,Maris MB,Hegenbart U,et al.Hematopoietic cell transplantation after nonmyeloablative conditioning for advanced chronic lymphocytic leukemia.J Clin O
18、ncol2005;23:3819-29.18%31%31%56%56%72%P Dreger1,R Brand2,Treatment-related mortality and graft-versus-leukemia activity after allogeneic stem cell transplantation for chronic lymphocytic leukemia using intensity-reduced conditioning。Leukemia(2003)17,841848.Norbert Schmitz,Peter Dreger.Allogeneic tra
19、nsplantation in lymphoma:current status.Haematologica 2007;92:1533-1548.Avivi I,Canals C,et al.Matched unrelated donor stem cell transplantation for patients with diffuse large B cell lymphoma:A retrospective analysis of 118 patients registered through the European Group for Blood and Marrow Transpl
20、antation(EBMT).Blood 2006;08:602abstract.Frdric Baron,Factors Associated With Outcomes in Allogeneic Hematopoietic Cell Transplantation With Nonmyeloablative Conditioning After Failed Myeloablative Hematopoietic Cell Transplantation VOLUME 24 NUMBER 25 SEPTEMBER 1 2006MD Anderson,JCO 2004;22:2419MD
21、Anderson,JCO 2004;22:2419利妥昔单抗：利妥昔单抗：1.增强化疗敏感性，d-132.与氟达拉宾的协同作用,d-63.清除MRD，d+1,d+84.增强GVL作用5.减轻GVHD作用？MD Anderson,JCO 2004;22:2419MD Anderson,Blood.2008MD Anderson,Blood.2008OSEFSGVHDcGVHDOS and PFS were 85%and 83%,respectively,with a median follow-up of 60 months(19-94).Seattle,Blood,2008无不良预后因素HCT-CI=0结果经移植前的年龄、化疗情况、CMV感染情况、疾病种类与分期、供体、干细胞来源进行校正后的结果清髓有不良预后因素HCT-CI1非清髓校正后的非清髓Auto-vs allo-SCT for lymphomas
