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T 细胞耗竭的无关供者干细胞移植可为血液系统恶性肿瘤的成人提供有利的无病生存。

T cell-depleted unrelated donor stem cell transplantation provides favorable disease-free survival for adults with hematologic malignancies.

机构信息

Adult Allogeneic Bone Marrow Transplant Service, Division of Hematologic-Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, Weill Medical College of Cornell University, New York, New York 10065, USA.

出版信息

Biol Blood Marrow Transplant. 2011 Sep;17(9):1335-42. doi: 10.1016/j.bbmt.2011.01.005. Epub 2011 Jan 11.

Abstract

We report a prospective phase II clinical trial in 35 adult patients (median age 40.5 years) with hematologic malignancies who received T cell-depleted, hematopoietic stem cell transplants from HLA-compatible, unrelated donors. The cytoreductive regimen consisted of hyperfractionated total-body irradiation, thiotepa, and fludarabine. The preferred graft source was granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood stem cells (PBSC). PBSC were CD34(+) selected, followed by sheep erythrocyte rosetting to deplete residual T cells. Anti-thymocyte globulin provided graft rejection prophylaxis. No additional graft-versus-host disease (GVHD) prophylaxis was planned. Estimated disease-free survival at 4 years is 56.8% for the entire group and 75% in patients with standard-risk disease. The cumulative incidence of relapse is 6%. Acute GVHD grade II-III developed in 9% and chronic GVHD in 29% of patients. Fatal infections occurred in 5 of 35 (14%) patients. There was 1 late graft failure. This study demonstrates durable engraftment with a low overall incidence of GVHD. Its curative potential is reflected in the remarkably low relapse rate at 4 years.

摘要

我们报告了一项针对 35 名血液系统恶性肿瘤成年患者(中位年龄 40.5 岁)的前瞻性 II 期临床试验,这些患者接受了 HLA 相容的非亲缘供体的 T 细胞耗竭性造血干细胞移植。细胞减灭方案包括超分割全身照射、噻替哌和氟达拉滨。首选的移植物来源是粒细胞集落刺激因子(G-CSF)动员的外周血干细胞(PBSC)。PBSC 进行 CD34+选择,然后用绵羊红细胞花环法去除残留的 T 细胞。抗胸腺细胞球蛋白提供移植物排斥预防。未计划进行额外的移植物抗宿主病(GVHD)预防。整个组的 4 年无病生存率为 56.8%,标准风险疾病患者为 75%。累积复发率为 6%。9%的患者发生 II-III 级急性 GVHD,29%的患者发生慢性 GVHD。5 例(14%)患者发生致命性感染。有 1 例晚期移植物失败。这项研究表明,GVHD 总发生率低,可实现持久的植入。4 年时的低复发率反映了其显著的治愈潜力。

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