天津血液肿瘤高峰论坛 |张翼鷟教授:弥漫大B细胞淋巴瘤造血干细胞移植进展

2017-11-08 佚名 ioncology

2017年11月3~5日,第四届天津血液肿瘤高峰论坛在天津市肿瘤医院隆重召开。本次论坛邀请到了国内众多血液肿瘤学著名专家,共同探讨恶性血液肿瘤的诊治及研究进展。近年来,造血干细胞移植仍然是恶性血液肿瘤治疗中最重要的治疗手段,可以挽救患者生命。

2017年11月3~5日,第四届天津血液肿瘤高峰论坛在天津市肿瘤医院隆重召开。本次论坛邀请到了国内众多血液肿瘤学著名专家,共同探讨恶性血液肿瘤的诊治及研究进展。近年来,造血干细胞移植仍然是恶性血液肿瘤治疗中最重要的治疗手段,可以挽救患者生命。会上,天津医科大学肿瘤医院张翼鷟教授针对造血干细胞移植在弥漫大B细胞淋巴瘤治疗中的进展做了精彩报告,《肿瘤瞭望》极为荣幸地邀请到张教授针对该话题进行了深度访谈。现将其整理成文,以供读者参考。

年轻中高危患者是否推荐一线自体造血干细胞移植?

张教授:这是个非常有争议的问题。在没有靶向药物(比如CD20单抗)的时代,高危、中高危患者进行一线自体造血干细胞移植巩固是得到公认的。原因是有多个前瞻性临床研究都证实与常规化疗相比,患者的PFS、OS得到了改善。但是在利妥昔单抗出现之后,一线ASCT在DLBCL中的应用受到了挑战。不同的研究得到的结论不同,比如一项荟萃分析结合了10余项临床研究,纳入2000多名患者,其汇总结果显示,移植组和非移植组患者并未显示明显的生存差别。但也有研究认为高危或中高危亚组可从移植中获益,也有研究得出阴性结果。基于上述研究结论的不一致性,目前针对DLBCL患者的ASCT在指南中仅作为推荐,且推荐级别不高。但对于复发难治DLBCL,不论是利妥昔单抗出现之前还是之后,ASCT的地位依然是非常稳固的。

进行异基因造血干细胞移植时机如何选择?

张教授:我们对异基因造血干细胞移植在DLBCL中的应用应持审慎的态度。除非是ASCT后复发,复发后IPI评分很高,特别新出现高危分子遗传学异常等不良预后因素的患者可考虑行异基因造血干细胞移植。当然这其中需要权衡很多因素,比如患者身体状况,ASCT后复发时间早晚,供者情况等。移植时机尽量选择患者获得一定程度的缓解时进行,否则对化疗不敏感的患者行异基因造血干细胞移植可能也是徒劳无益的。

移植后复发的患者如何选择治疗策略,是否进行二次移植?

张教授: ASCT后复发的患者可选择挽救性免疫化疗,根据既往用药情况选择没有用过的药物制定挽救治疗方案。发展空间更大的是新药,在新药与敏感化疗药物的帮助下如果患者获得较好的缓解,那么有价值进行二次移植。甚至具有高危因素的患者在ASCT复发后也可考虑异基因造血干细胞移植。

对于老年高危DLBCL患者,减低预处理剂量的自体移植是否可行?有无价值?

张教授:目前这个问题还没有得到临床上的广泛关注。我们知道,双打击或三打击淋巴瘤本身发病率低,属于少见病,在老年患者中的发病率也类似,因此病例数较少,对这部分患者进行减低预处理强度移植的大样本研究存在一定困难。这可能是个有意义的尝试,毕竟目前双打击或三打击DLBCL的治疗手段有局限,但我认为移植可能不是主要方向,未来还是应该依靠新药来解决这部分患者的问题。

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    2017-11-10 俅侠

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