Schots R, Van Riet I, Ben Othman T, Trullemans F, De Waele M, Van Camp B
BMT-Unit, AZ-Vrije Universiteit Brussel, Belgium.
Bone Marrow Transplant. 2001 Nov;28(10):917-22. doi: 10.1038/sj.bmt.1703268.
In this single-center study, a consecutive cohort of 59 adult patients transplanted with HLA-identical bone marrow and receiving graft-versus-host disease (GVHD) prophylaxis with either standard cyclosporine/methotrexate (n = 33) or partial T cell depletion (E-rosetting) (TCD, n = 26 were analyzed). Only patients with chronic myeloid leukemia in first chronic phase or acute leukemia/myelodysplasia in first or second remission were included. Except for age (median 28 vs 42 years), both groups were comparable in terms of diagnosis, conditioning regimen and growth factor support. TCD significantly reduced >grade II acute GVHD (0 vs 24%, P = 0.02), chronic GVHD (8.5 vs 45%, P = 0.007) and other major bone marrow transplant (BMT)-related complications (4 vs 36%, P = 0.005). TCD decreased overall transplant-related mortality (11.5 vs 36%, P = 0.04). In the TCD group faster neutrophil (13 vs 22 days, P = 0.02) and platelet recoveries (18 vs 26 days, P < 0.001) were noted. The relapse risk was higher after TCD (57.5 vs 21.5%, P = 0.04). Overall survival probability at 10 years was identical in both groups (54 vs 53.5%, P = 0.33). We found a relationship between the number of T cells in the graft and the occurrence of major complications (P < 0.001) and relapse (P = 0.03). This comparative analysis shows that graft-derived T cells have a major role in overall BMT-related toxicity and that partial TCD is an acceptable approach in terms of survival for patients between 40 and 50 years of age.
在这项单中心研究中，对59例接受 HLA 相同骨髓移植且接受移植物抗宿主病（GVHD）预防的成年患者进行了连续队列分析，其中33例采用标准环孢素/甲氨蝶呤预防（n = 33），26例采用部分T细胞清除（E 花环法）预防（TCD，n = 26）。仅纳入处于慢性期的慢性粒细胞白血病患者或处于首次或第二次缓解期的急性白血病/骨髓增生异常综合征患者。除年龄（中位数分别为28岁和42岁）外，两组在诊断、预处理方案和生长因子支持方面具有可比性。TCD 显著降低了＞Ⅱ级急性 GVHD（0% 对24%，P = 0.02）、慢性 GVHD（8.5% 对45%，P = 0.007）以及其他主要的骨髓移植（BMT）相关并发症（4% 对36%，P = 0.005）。TCD 降低了总体移植相关死亡率（11.5% 对36%，P = 0.04）。在TCD组中，中性粒细胞恢复更快（13天对22天，P = 0.02），血小板恢复也更快（18天对26天，P ＜ 0.001）。TCD后复发风险更高（57.5% 对21.5%，P = 0.04）。两组10年总生存概率相同（54% 对53.5%，P = 0.33）。我们发现移植物中T细胞数量与主要并发症的发生（P＜ 0.001）和复发（P = 0.03）之间存在关联。这项比较分析表明，移植物来源的T细胞在总体BMT相关毒性中起主要作用，对于40至50岁的患者而言，部分TCD在生存方面是一种可接受的方法。
