人类白细胞抗原匹配的同胞供者造血细胞移植治疗慢性淋巴细胞白血病的疗效：清髓性与减低强度预处理方案对比
Outcomes of human leukocyte antigen-matched sibling donor hematopoietic cell transplantation in chronic lymphocytic leukemia: myeloablative versus reduced-intensity conditioning regimens.
作者信息
Sobecks Ronald M, Leis Jose F, Gale Robert Peter, Ahn Kwang Woo, Zhu Xiaochun, Sabloff Mitchell, de Lima Marcos, Brown Jennifer R, Inamoto Yoshihiro, Hale Gregory A, Aljurf Mahmoud D, Kamble Rammurti T, Hsu Jack W, Pavletic Steven Z, Wirk Baldeep, Seftel Matthew D, Lewis Ian D, Alyea Edwin P, Cortes Jorge, Kalaycio Matt E, Maziarz Richard T, Saber Wael
机构信息
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Hematology/Oncology, Mayo Clinic Arizona, Phoenix, Arizona; Phoenix Children's Hospital, Phoenix, Arizona.
出版信息
Biol Blood Marrow Transplant. 2014 Sep;20(9):1390-8. doi: 10.1016/j.bbmt.2014.05.020. Epub 2014 May 28.
Allogeneic hematopoietic cell transplantation (HCT) can cure some chronic lymphocytic leukemia (CLL) subjects. This study compared outcomes of myeloablative (MA) and reduced-intensity conditioning (RIC) transplants from HLA-matched sibling donors (MSD) for CLL. From 1995 to 2007, information regarding 297 CLL subjects was reported to the Center of International Blood and Marrow Transplant Research; of these, 163 underwent MA and 134 underwent RIC MSD HCT. The MA subjects underwent transplantation less often after 2000 and less commonly received antithymocyte globulin (4% versus 13%, P = .004) or prior antibody therapy (14% versus 53%; P < .001). RIC was associated with a greater likelihood of platelet recovery and less grade 2 to 4 acute graft-versus-host disease compared with MA conditioning. One- and 5-year treatment-related mortality (TRM) were 24% (95% confidence intervals [CI], 16% to 33%) versus 37% (95% CI, 30% to 45%; P = .023), and 40% (95% CI, 29% to 51%) versus 54% (95% CI, 46% to 62%; P = .036), respectively, and the relapse/progression rates at 1 and 5 years were 21% (95% CI, 14% to 29%) versus 10% (95% CI, 6% to 15%; P = .020), and 35% (95% CI, 26% to 46%) versus 17% (95% CI, 12% to 24%; P = .003), respectively. MA conditioning was associated with better progression-free (PFS) (relative risk, .60; 95% CI, .37 to .97; P = .038) and 3-year survival in transplantations before 2001, but for subsequent years, RIC was associated with better PFS and survival (relative risk, 1.49 [95% CI, .92 to 2.42]; P = .10; and relative risk, 1.86 [95% CI, 1.11 to 3.13]; P = .019). Pretransplantation disease status was the most important predictor of relapse (P = .003) and PFS (P = .0007) for both forms of transplantation conditioning. MA and RIC MSD transplantations are effective for CLL. Future strategies to decrease TRM and reduce relapses are warranted.
异基因造血细胞移植（HCT）可治愈部分慢性淋巴细胞白血病（CLL）患者。本研究比较了来自人类白细胞抗原（HLA）相合同胞供者（MSD）的清髓性（MA）和减低强度预处理（RIC）移植治疗CLL的疗效。1995年至2007年，国际血液和骨髓移植研究中心收到了297例CLL患者的信息；其中，163例行MA移植，134例行RIC MSD-HCT。2000年后，MA组患者接受移植的频率较低，接受抗胸腺细胞球蛋白治疗的比例也较低（4%对13%，P = 0.004），或接受过抗体治疗的比例也较低（14%对53%；P < 0.001）。与MA预处理相比，RIC与血小板恢复的可能性更大以及2至4级急性移植物抗宿主病的发生率更低相关。1年和5年的治疗相关死亡率（TRM）分别为24%（95%置信区间[CI]，16%至33%）对37%（95%CI，30%至45%；P = 0.023），以及40%（95%CI，29%至51%）对54%（95%CI，46%至62%；P = 0.036），1年和5年的复发/进展率分别为21%（95%CI，14%至29%）对10%（95%CI，6%至15%；P = 0.020），以及35%（95%CI，26%至46%）对17%（95%CI，12%至24%；P = 0.003）。在2001年前的移植中，MA预处理与更好的无进展生存期（PFS）（相对风险，0.60；95%CI，0.37至0.97；P = 0.038）和3年生存率相关，但在随后几年中，RIC与更好的PFS和生存率相关（相对风险，1.49[95%CI，0.92至2.42]；P = 0.10；以及相对风险，1.86[95%CI，1.11至3.13]；P = 0.019）。移植前疾病状态是两种移植预处理方式复发（P = 0.003）和PFS（P = 0.0007）的最重要预测因素。MA和RIC MSD移植对CLL有效。有必要采取未来策略来降低TRM并减少复发。
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