非清髓性预处理、未处理的单倍体相合造血干细胞移植及输注后环磷酰胺用于晚期淋巴瘤治疗
Nonmyeloablative conditioning, unmanipulated haploidentical SCT and post-infusion CY for advanced lymphomas.
作者信息
Castagna L, Bramanti S, Furst S, Giordano L, Crocchiolo R, Sarina B, Mauro E, Morabito L, Bouabdallah R, Coso D, Balzarotti M, Broussais F, El-Cheikh J, Stella C C, Brusamolino E, Blaise D, Santoro A
机构信息
1] Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Milan, Italy [2] Hematology Department, Institut Paoli Calmettes 232, Boulevard S Marguerite, Marseille, France.
Hematology Department, Humanitas Cancer Center, Istituto Clinico Humanitas, Milan, Italy.
出版信息
Bone Marrow Transplant. 2014 Dec;49(12):1475-80. doi: 10.1038/bmt.2014.197. Epub 2014 Sep 15.
Allo-SCT is regularly performed in advanced lymphoma. Haploidentical family donors are a valuable source of hematopoietic stem cells and transplants from these donors, using T-repleted grafts, has recently been successfully reported. We report on 49 patients with refractory lymphoma who received T-repleted haploidentical SCT with a non-myeloablative regimen and post-transplant CY. The median time to recover ANC >0.5 × 10e9/L and transfusion independent plt count >20 × 10e9/L was 20 days (range 14-38) and 26 days (range 14-395). The probability to reach ANC >0.5 × 10e9/L at 30 days was 87% and transfusion independent plt count >20 × 10e9/L at 100 days was 87%. The cumulative incidence of grade 2-4 acute GVHD (aGVHD) was 25.6% (95% confidence interval (CI): 12.9-38.3%) and the cumulative incidence of chronic GVHD (cGVHD) was 5.2% (95% CI: 0-12.4%). The median follow-up is 20.6 months (range 12-54), and the projected 2-year OS and PFS were 71 and 63%. The relapse rate was 18.7% (95% CI: 7.6-29.8%) and the median time to relapse was 4.4 months (range 1.1-8.3). At 2 years, cumulative incidence of NRM was 16.3% (95% CI: 5.9-26.8%). T-repleted Haploidentical transplantation with post-infusion CY is a feasible and effective therapy in the poor prognosis of advanced lymphoma patients.
异基因造血干细胞移植（Allo-SCT）常用于晚期淋巴瘤的治疗。单倍体相合的家族供者是造血干细胞的宝贵来源，近期有报道称使用富含T细胞的移植物进行来自这些供者的移植已获成功。我们报告了49例难治性淋巴瘤患者，他们接受了采用非清髓性方案及移植后环磷酰胺（CY）的富含T细胞的单倍体相合造血干细胞移植。中性粒细胞绝对值（ANC）>0.5×10⁹/L及血小板计数无需输血支持>20×10⁹/L的中位恢复时间分别为20天（范围14 - 38天）和26天（范围14 - 395天）。30天时ANC>0.5×10⁹/L的概率为87%，100天时血小板计数无需输血支持>20×10⁹/L的概率为87%。2 - 4级急性移植物抗宿主病（aGVHD）的累积发生率为25.6%（95%置信区间（CI）：12.9 - 38.3%），慢性移植物抗宿主病（cGVHD）的累积发生率为5.2%（95%CI：0 - 12.4%）。中位随访时间为20.6个月（范围12 - 54个月），预计2年总生存率（OS）和无进展生存率（PFS）分别为71%和63%。复发率为18.7%（95%CI：7.6 - 29.8%），中位复发时间为4.4个月（范围1.1 - 8.3个月）。2年时，非复发死亡率（NRM）的累积发生率为16.3%（95%CI：5.9 - 26.8%）。采用移植后输注CY的富含T细胞的单倍体相合移植对于晚期淋巴瘤患者的不良预后是一种可行且有效的治疗方法。
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