Xavier Erick, Cornillon Jérôme, Ruggeri Annalisa, Chevallier Patrice, Cornelissen Jan J, Andersen Niels S, Maillard Natacha, Nguyen Stephanie, Blaise Didier, Deconinck Eric, Veelken Hendrik, Milpied Noel, Van Gelder Michel, Peffault de Latour Regis, Gluckman Eliane, Kröger Nicolaus, Schetelig Johannes, Rocha Vanderson
Eurocord International Registry, Hôpital Saint-Louis, Paris, France.
Department of Hematology, Cancer Institute Lucien Neuwirth, Saint Etienne, France.
Biol Blood Marrow Transplant. 2015 Aug;21(8):1515-23. doi: 10.1016/j.bbmt.2015.04.026. Epub 2015 May 7.
Outcomes after umbilical cord blood transplantation (UCBT) for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) are unknown. We analyzed outcomes of 68 patients with poor-risk CLL/SLL who underwent reduced-intensity (RIC) UCBT from 2004 to 2012. The median age was 57 years and median follow-up 36 months; 17 patients had del 17p/p53mutation, 19 patients had fludarabine-refractory disease, 11 relapsed after autologous stem cell transplantation, 8 had diagnosis of prolymphocytic leukemia, 4 had Richter syndrome, and 8 underwent transplantation with progressive or refractory disease. The most common RIC used was cyclophosphamide, fludarabine, and total body irradiation (TBI) in 82%; 15 patients received antithymocyte globulin. Most of the cord blood grafts were HLA mismatched and 76% received a double UCBT. Median total nucleated cells collected was 4.7 × 10(7)/kg. The cumulative incidences (CI) of neutrophil and platelet engraftment were 84% and 72% at 60 and 180 days respectively; day 100 graft-versus-host disease (GVHD) (grade II to IV) was 43% and 3-year chronic GVHD was 32%. The CI of relapse, nonrelapse mortality, overall survival, and progression-free survival (PFS) at 3 years were 16%, 39%, 54%, and 45%, respectively. Fludarabine-sensitive disease at transplantation and use of low-dose TBI regimens were associated with acceptable PFS. In conclusion, use of RIC-UCBT seems to be feasible in patients with poor-risk CLL/SLL and improved outcomes were observed in patients with fludarabine-sensitive disease who received low-dose TBI regimens.
慢性淋巴细胞白血病（CLL）/小淋巴细胞淋巴瘤（SLL）患者接受脐带血移植（UCBT）后的结局尚不清楚。我们分析了2004年至2012年间68例接受减低强度（RIC）UCBT的高危CLL/SLL患者的结局。中位年龄为57岁，中位随访时间为36个月；17例患者存在17p/del p53突变，19例患者患有氟达拉滨难治性疾病，11例在自体干细胞移植后复发，8例诊断为幼淋巴细胞白血病，4例患有Richter综合征，8例在疾病进展或难治时接受移植。最常用的RIC方案是82%的患者使用环磷酰胺、氟达拉滨和全身照射（TBI）；15例患者接受了抗胸腺细胞球蛋白治疗。大多数脐带血移植物为HLA不匹配，76%的患者接受了双份UCBT。采集的中位总核细胞数为4.7×10⁷/kg。中性粒细胞和血小板植入的累积发生率（CI）在60天和180天时分别为84%和72%；100天时移植物抗宿主病（GVHD）（II至IV级）为43%，3年慢性GVHD为32%。3年时复发、非复发死亡率、总生存率和无进展生存率（PFS）的CI分别为16%、39%、54%和45%。移植时对氟达拉滨敏感的疾病以及使用低剂量TBI方案与可接受的PFS相关。总之，对于高危CLL/SLL患者，使用RIC-UCBT似乎是可行的，并且在接受低剂量TBI方案的对氟达拉滨敏感的疾病患者中观察到了改善的结局。
