Novitzky Nicolas, Thomas Valda, du Toit Cecile, Mcdonald Andrew
Division of Haematology, University of Cape Town and Grotte Schuur Hospital, Cape Town, 7925 South Africa.
Biol Blood Marrow Transplant. 2008 Jun;14(6):709-18. doi: 10.1016/j.bbmt.2008.01.007.
Myeloablative conditioning followed by T-cell depletion of grafts and reduced intensity conditioning (RIC) has both been shown to decrease treatment related mortality (TRM). However in RIC the incidence of graft vs. host disease (GvHD) is high and patients with aggressive diseases tend to relapse. Following myeloablative conditioning, patients with chemotherapy-responsive hematological malignancies underwent transplantation from HLA identical siblings. GvHD prophylaxis was by ex viva T-cell depletion with alemtuzumab. The outcome of these patients was analysed. At transplantation, the median age of 81 consecutive individuals was 45 years (range 15-60). GvHD was seen in 10% and was commonly associated with infections resulting in one and 3 year TRM of 15 and 20.5%. Fifteen patients relapsed, 10 who had myeloproliferative syndromes or lymphoma and two with myeloma responded to DLI. For the whole group, median follow up is 777 (range 7-2702) days and 73% remain disease free. Cox regression analysis for survival showed that only occurrence of GvHD was a significant adverse factor. Age order than median was not associated with worse outcome. By reducing the incidence and severity of GvHD, T-cell depletion of grafts leads to greater tolerance to myeloablative chemotherapy, resulting in acceptable TRM. This strategy should be compared with the RIC approaches.
清髓性预处理后进行移植物T细胞去除以及减低剂量预处理（RIC）均已显示可降低治疗相关死亡率（TRM）。然而，在RIC中，移植物抗宿主病（GvHD）的发生率较高，侵袭性疾病患者往往会复发。在清髓性预处理后，化疗反应性血液系统恶性肿瘤患者接受了来自 HLA 相同同胞的移植。通过阿仑单抗进行体外T细胞去除来预防GvHD。分析了这些患者的结局。在移植时，81例连续患者的中位年龄为45岁（范围15 - 60岁）。10%的患者出现了GvHD，且通常与感染相关，导致1年和3年的TRM分别为15%和20.5%。15例患者复发，10例患有骨髓增殖性综合征或淋巴瘤，2例骨髓瘤患者对供体淋巴细胞输注（DLI）有反应。对于整个组，中位随访时间为777天（范围7 - 2702天），73%的患者仍无疾病。生存的Cox回归分析表明，只有GvHD的发生是一个显著的不良因素。年龄大于中位数与较差的结局无关。通过降低GvHD的发生率和严重程度，移植物T细胞去除可使患者对清髓性化疗有更高的耐受性，从而导致可接受的TRM。应将该策略与RIC方法进行比较。
