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