Department Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Ann Hematol. 2011 Mar;90(3):331-41. doi: 10.1007/s00277-010-1081-3. Epub 2010 Sep 25.
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only curative therapy for chronic myelogenous leukemia (CML). In this study, the long-term outcomes of HLA-matched sibling donor (MSD) with mismatched related donor (MRD) and unrelated donor (URD) transplantation for CML in the first chronic phase (CML-CP1) using different graft vs. host disease (GVHD) prophylaxis regimens according to donor source and the degree of HLA matching were compared. The data of 91 patients with CML-CP1 were analyzed with respect to GVHD, overall survival (OS), and transplant-related mortality (TRM). The incidence of grade II-IV acute GVHD was 25.5% in the MSD and 40.5% in the MRD/URD group (P = 0.133). The 1-year cumulative incidence of chronic GVHD was not different between the MSD and the MRD/URD groups, while extensive chronic GVHD was different between the two groups (31.9% vs. 10.8%, P = 0.023). The 5-year cumulative relapse rate was not different between the MSD and the MRD/URD groups, while TRM was different between the two groups (6.6% vs. 26.3%, P = 0.010). The 5-year cumulative OS was 90.9%, 71.5%, and 85.4% in the MSD, the MRD/URD, and the HLA allele-matched URD transplantation, respectively (MSD vs. MRD/URD, P = 0.013; MSD vs. HLA allele-matched URD, P = 0.437). In conclusion, survival in HLA allele-matched URD is equivalent to MSD, but in MRD and mismatched URD is inferior to MSD in patients with CML-CP1 undergoing allo-HSCT using different GVHD prophylaxis regimens according to donor source and degree of HLA matching. Patients undergoing MRD/URD transplantation have an equal quality of life as patients undergoing MSD transplantation.
异基因造血干细胞移植（allo-HSCT）仍然是治疗慢性髓系白血病（CML）的唯一根治方法。本研究比较了根据供体来源和 HLA 匹配程度采用不同移植物抗宿主病（GVHD）预防方案，在慢性期 1 期（CML-CP1）接受 HLA 匹配的同胞供体（MSD）、有 mismatched 相关供体（MRD）和无关供体（URD）移植的 CML 患者的长期结果。对 91 例 CML-CP1 患者的 GVHD、总生存率（OS）和移植相关死亡率（TRM）数据进行了分析。MSD 组和 MRD/URD 组的 II-IV 级急性 GVHD 发生率分别为 25.5%和 40.5%（P=0.133）。MSD 组和 MRD/URD 组的 1 年慢性 GVHD 累积发生率无差异，但两组广泛慢性 GVHD 发生率有差异（31.9% vs. 10.8%，P=0.023）。MSD 组和 MRD/URD 组的 5 年累积复发率无差异，但两组的 TRM 有差异（6.6% vs. 26.3%，P=0.010）。MSD、MRD/URD 和 HLA 等位基因匹配 URD 移植的 5 年累积 OS 分别为 90.9%、71.5%和 85.4%（MSD 与 MRD/URD，P=0.013；MSD 与 HLA 等位基因匹配 URD，P=0.437）。结论是，在根据供体来源和 HLA 匹配程度采用不同 GVHD 预防方案，在 CML-CP1 患者中接受 allo-HSCT 时，HLA 等位基因匹配 URD 的生存率与 MSD 相当，但在 MRD 和 mismatched URD 中不如 MSD。接受 MRD/URD 移植的患者与接受 MSD 移植的患者具有相同的生活质量。
