单倍体相合移植联合移植后环磷酰胺与匹配无关供者移植治疗急性髓系白血病
Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia.
作者信息
Ciurea Stefan O, Zhang Mei-Jie, Bacigalupo Andrea A, Bashey Asad, Appelbaum Frederick R, Aljitawi Omar S, Armand Philippe, Antin Joseph H, Chen Junfang, Devine Steven M, Fowler Daniel H, Luznik Leo, Nakamura Ryotaro, O'Donnell Paul V, Perales Miguel-Angel, Pingali Sai Ravi, Porter David L, Riches Marcie R, Ringdén Olle T H, Rocha Vanderson, Vij Ravi, Weisdorf Daniel J, Champlin Richard E, Horowitz Mary M, Fuchs Ephraim J, Eapen Mary
机构信息
Department of Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX;
Department of Medicine, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI;
出版信息
Blood. 2015 Aug 20;126(8):1033-40. doi: 10.1182/blood-2015-04-639831. Epub 2015 Jun 30.
We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P = .38). Corresponding rates after reduced intensity conditioning transplants were 46% (95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical power is limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.
我们研究了接受单倍体相合（n = 192）和8/8 HLA配型相合的无关供者（n = 1982）移植后的急性髓系白血病（AML）成年患者。单倍体相合受者接受钙调神经磷酸酶抑制剂（CNI）、霉酚酸酯和移植后环磷酰胺预防移植物抗宿主病（GVHD）；104例患者接受清髓性预处理，88例接受减低强度预处理方案。配型相合的无关供者移植受者接受CNI联合霉酚酸酯或甲氨蝶呤预防GVHD；1245例患者接受清髓性预处理，737例接受减低强度预处理方案。在清髓性预处理情况下，单倍体相合移植后第30天中性粒细胞恢复率低于配型相合的无关供者移植（90%对97%，P = 0.02）。减低强度预处理移植后的相应发生率分别为93%和96%（P = 0.25）。在清髓性预处理情况下，单倍体相合移植后3个月急性2 - 4级GVHD（16%对33%，P < 0.0001）和3年慢性GVHD（30%对53%，P < 0.0001）低于配型相合的无关供者移植。减低强度预处理移植后也观察到类似差异，分别为19%对28%（P = 0.05）和34%对52%（P = 0.002）。在接受清髓性预处理方案的患者中，单倍体相合和配型相合的无关供者移植后3年总生存率分别为45%（95% CI，36 - 54）和50%（95% CI，47 - 53）（P = 0.38）。减低强度预处理移植后的相应发生率分别为46%（95% CI，35 - 56）和44%（95% CI，0.40 - 47）（P = 0.71）。尽管统计效能有限，但这些数据表明，接受移植后环磷酰胺的单倍体相合移植的AML患者生存率与配型相合的无关供者移植相当。
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