Faulkner Rowena D, Craddock Charles, Byrne Jennifer L, Mahendra Prem, Haynes Andrew P, Prentice Hugh G, Potter Michael, Pagliuca Antonio, Ho Aloysius, Devereux Stephen, McQuaker Grant, Mufti Ghulam, Yin John Liu, Russell Nigel H
Academic Haematology, Clinical Sciences Bldg, City Hospital, Nottingham, NG5 1PB United Kingdom.
Blood. 2004 Jan 15;103(2):428-34. doi: 10.1182/blood-2003-05-1406. Epub 2003 Sep 11.
We report the outcomes of reduced-intensity allogeneic stem cell transplantation using BEAM-alemtuzumab conditioning (carmustine, etoposide, cytosine arabinoside, melphalan, and alemtuzumab 10 mg/d on days -5 to -1) in 6 United Kingdom transplant centers. Sixty-five patients with lymphoproliferative diseases underwent sibling (n = 57) or matched unrelated donor (n = 8) transplantation. Sustained donor engraftment occurred in 60 (97%) of 62 patients. Of the 56 patients undergoing chimerism studies, 35 (63%) had full donor chimerism. Overall, 73% were in complete remission (CR) after transplantation. At a median follow-up of 1.4 years (range, 0.1-5.6 years), 37 remain alive and in CR. Acute graft-versus-host disease (GVHD) occurred in 11 (17%) of 64, grades I-II only. Estimated 1-year transplantation-related mortality (TRM) was 8% for patients undergoing first transplantation but was significantly worse for those who had previously undergone autologous transplantation. Six patients relapsed (estimated 2-year relapse risk, 20%). Histologic diagnosis (mantle cell lymphoma and high-grade non-Hodgkin lymphoma) and age at transplantation (> 46 years) were significantly associated with higher relapse risk and worse event-free survival. Relapse did not occur in any patient who developed acute or chronic GVHD. This study demonstrates that reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases using a BEAM-alemtuzumab preparative regimen is associated with sustained donor engraftment, a high response rate, minimal toxicity, and a low incidence of GVHD.
我们报告了英国6个移植中心使用BEAM-阿仑单抗预处理方案（卡莫司汀、依托泊苷、阿糖胞苷、美法仑，以及在第-5天至-1天给予阿仑单抗10mg/d）进行的减低强度异基因干细胞移植的结果。65例淋巴增殖性疾病患者接受了同胞供者（n = 57）或匹配的无关供者（n = 8）移植。62例患者中有60例（97%）实现了供者持续植入。在接受嵌合状态研究的56例患者中，35例（63%）达到完全供者嵌合。总体而言，73%的患者移植后处于完全缓解（CR）状态。在中位随访1.4年（范围0.1 - 5.6年）时，37例患者仍存活且处于CR状态。64例患者中有11例（17%）发生了急性移植物抗宿主病（GVHD），均为I - II级。首次移植患者的估计1年移植相关死亡率（TRM）为8%，但既往接受过自体移植的患者情况明显更差。6例患者复发（估计2年复发风险为20%）。组织学诊断（套细胞淋巴瘤和高级别非霍奇金淋巴瘤）以及移植时的年龄（> 46岁）与较高的复发风险和较差的无事件生存率显著相关。发生急性或慢性GVHD的患者均未复发。本研究表明，使用BEAM-阿仑单抗预处理方案进行的淋巴增殖性疾病减低强度异基因干细胞移植与供者持续植入、高缓解率、最小毒性以及低GVHD发生率相关。
