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在中国的单中心经验中,HLA 匹配的同胞供者与不匹配的亲缘和非亲缘供者造血干细胞移植治疗慢性期慢性髓性白血病的长期结果比较。

Long-term outcomes of HLA-matched sibling compared with mismatched related and unrelated donor hematopoietic stem cell transplantation for chronic phase chronic myelogenous leukemia: a single institution experience in China.

机构信息

Department Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

出版信息

Ann Hematol. 2011 Mar;90(3):331-41. doi: 10.1007/s00277-010-1081-3. Epub 2010 Sep 25.


DOI:10.1007/s00277-010-1081-3
PMID:20872002
Abstract

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.

摘要

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。

相似文献

[1]
Long-term outcomes of HLA-matched sibling compared with mismatched related and unrelated donor hematopoietic stem cell transplantation for chronic phase chronic myelogenous leukemia: a single institution experience in China.

Ann Hematol. 2010-9-25

[2]
Equivalent survival for sibling and unrelated donor allogeneic stem cell transplantation for acute myelogenous leukemia.

Biol Blood Marrow Transplant. 2007-5

[3]
HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for chronic myeloid leukemia: improved outcomes in patients in accelerated phase and blast crisis phase.

Ann Med. 2008

[4]
[Impact of HLA compatibility on the outcome of allogeneic hematopoietic stem cell transplantation for chronic myeloid leukemia].

Nan Fang Yi Ke Da Xue Xue Bao. 2011-3

[5]
[Effects and prognostic factors of HLA-matched sibling donor allogeneic hematopoietic stem cell transplantation for chronic myelogenous leukemia].

Zhonghua Zhong Liu Za Zhi. 2006-7

[6]
[Allogeneic hematopoietic stem cell transplantation from HLA one-locus-mismatched related donors].

Gan To Kagaku Ryoho. 2009-11

[7]
European results of matched unrelated donor bone marrow transplantation for chronic myeloid leukemia. Impact of HLA class II matching. Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation.

Bone Marrow Transplant. 1997-7

[8]
Related HLA-mismatched/haploidentical hematopoietic stem cell transplantation without in vitro T-cell depletion: observations of a single Chinese center.

Clin Transpl. 2011

[9]
CD6+ T cell depleted allogeneic bone marrow transplantation from genotypically HLA nonidentical related donors.

Biol Blood Marrow Transplant. 1997-4

[10]
Anti-thymocyte globulin overcomes the negative impact of HLA mismatching in transplantation from unrelated donors.

Exp Hematol. 2008-8

引用本文的文献

[1]
Comparable Outcomes of Pre- Versus Post-Tyrosine Kinase Inhibitor Era Treatment in Chronic Myeloid Leukemia: A Retrospective Cohort Study With Long-term Follow-up.

Cell Transplant. 2023

[2]
Allogeneic stem cell transplantation for chronic myeloid leukemia in the TKI era: population-based data from the Swedish CML registry.

Bone Marrow Transplant. 2019-4-8

[3]
Allogeneic transplantation for CML in the TKI era: striking the right balance.

Nat Rev Clin Oncol. 2015-11-17

[4]
Is Imatinib Maintenance Required for Patients with Relapse Chronic Myeloid Leukemia Post-Transplantation Obtaining CMR? A Pilot Retrospective Investigation.

PLoS One. 2013-6-18

[5]
Who is the better donor for older hematopoietic transplant recipients: an older-aged sibling or a young, matched unrelated volunteer?

Blood. 2013-1-29

[6]
NCCN Task Force report: tyrosine kinase inhibitor therapy selection in the management of patients with chronic myelogenous leukemia.

J Natl Compr Canc Netw. 2011-2

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