Northside Hospital, Atlanta, GA 30342, USA.
J Clin Oncol. 2013 Apr 1;31(10):1310-6. doi: 10.1200/JCO.2012.44.3523. Epub 2013 Feb 19.
T-cell-replete grafts from haploidentical donors using post-transplantation cyclophosphamide may represent a solution for patients who require allogeneic hematopoietic cell transplantation (alloHCT) but lack a conventional donor. We compared outcomes of alloHCT using haploidentical donors with those of transplantation using conventional HLA-matched sibling donors (MRDs) and HLA-matched unrelated donors (MUDs).
Outcomes of 271 consecutive patients undergoing T-cell-replete first alloHCT for hematologic malignancies performed contemporaneously at a single center (53 using haploidentical donors; 117, MRDs; 101, MUDs) were compared. Overall and disease-free survival (DFS) were adjusted for effects of significant patient-, disease-, and transplantation-related covariates using a stratified Cox model.
Patient characteristics were similar between the three donor groups. For patients undergoing MRD, MUD, and haploidentical transplantation, 24-month cumulative incidences of nonrelapse mortality were 13%, 16%, and 7% and of relapse were 34%, 34%, and 33%, respectively (P not significant [NS]). Cumulative incidences of grades 3 to 4 acute graft-versus-host disease (GVHD) at 6 months were 8%, 11%, and 11%, respectively (P NS); extensive chronic GVHD occurred in 54%, 54%, and 38% of patients, respectively (P < .05 for those undergoing haploidentical donor v MRD or MUD transplantation). Adjusted 24-month probabilities of survival were 76%, 67%, and 64% and of DFS were 53%, 52%, and 60%, respectively; these were not significantly different among the three donor groups.
Haploidentical transplantation performed using T-cell-replete grafts and post-transplantation cyclophosphamide achieves outcomes equivalent to those of contemporaneous transplantation performed using MRDs and MUDs. Such transplantation represents a valid alternative for patients who lack a conventional donor.
使用移植后环磷酰胺的单倍体供体来源的 T 细胞富含移植物可能为需要同种异体造血细胞移植（alloHCT）但缺乏常规供体的患者提供解决方案。我们比较了使用单倍体供体进行 alloHCT 的结果与使用常规 HLA 匹配的同胞供体（MRD）和 HLA 匹配的无关供体（MUD）进行移植的结果。
对同一中心连续进行的 271 例血液系统恶性肿瘤患者进行的 T 细胞富含的首次 alloHCT 进行了回顾性分析（53 例使用单倍体供体；117 例，MRD；101 例，MUD）。使用分层 Cox 模型，调整了患者、疾病和移植相关重要因素的影响后，评估了总生存率和无病生存率（DFS）。
三组供体患者的特征相似。对于接受 MRD、MUD 和单倍体移植的患者，24 个月无复发死亡率的累积发生率分别为 13%、16%和 7%，复发率分别为 34%、34%和 33%（P 无统计学意义[NS]）。6 个月时 3 级至 4 级急性移植物抗宿主病（GVHD）的累积发生率分别为 8%、11%和 11%（P NS）；分别有 54%、54%和 38%的患者发生广泛慢性 GVHD（P <.05 与接受单倍体供体或 MRD 或 MUD 移植的患者相比）。调整后的 24 个月生存率分别为 76%、67%和 64%，DFS 分别为 53%、52%和 60%；三组供体之间无显著差异。
使用 T 细胞富含移植物和移植后环磷酰胺的单倍体移植可获得与同期使用 MRD 和 MUD 进行移植相当的结果。这种移植为缺乏常规供体的患者提供了一种有效的替代方案。
