使用单倍体相合相关供者与 HLA 配型相合无关供者进行淋巴瘤的减低剂量预处理移植。
Reduced-intensity transplantation for lymphomas using haploidentical related donors vs HLA-matched unrelated donors.
作者信息
Kanate Abraham S, Mussetti Alberto, Kharfan-Dabaja Mohamed A, Ahn Kwang W, DiGilio Alyssa, Beitinjaneh Amer, Chhabra Saurabh, Fenske Timothy S, Freytes Cesar, Gale Robert Peter, Ganguly Siddhartha, Hertzberg Mark, Klyuchnikov Evgeny, Lazarus Hillard M, Olsson Richard, Perales Miguel-Angel, Rezvani Andrew, Riches Marcie, Saad Ayman, Slavin Shimon, Smith Sonali M, Sureda Anna, Yared Jean, Ciurea Stefan, Armand Philippe, Salit Rachel, Bolaños-Meade Javier, Hamadani Mehdi
机构信息
Osborn Hematopoietic Malignancy and Transplantation Program, West Virginia University, Morgantown, WV;
S.C. Ematologia e Trapianto di Midollo Osseo, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Istituto Nazionale dei Tumori, Milan, Italy;
出版信息
Blood. 2016 Feb 18;127(7):938-47. doi: 10.1182/blood-2015-09-671834. Epub 2015 Dec 15.
We evaluated 917 adult lymphoma patients who received haploidentical (n = 185) or HLA-matched unrelated donor (URD) transplantation either with (n = 241) or without antithymocyte globulin (ATG; n = 491) following reduced-intensity conditioning regimens. Haploidentical recipients received posttransplant cyclophosphamide-based graft-versus-host disease (GVHD) prophylaxis, whereas URD recipients received calcineurin inhibitor-based prophylaxis. Median follow-up of survivors was 3 years. The 100-day cumulative incidence of grade III-IV acute GVHD on univariate analysis was 8%, 12%, and 17% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .44). Corresponding 1-year rates of chronic GVHD on univariate analysis were 13%, 51%, and 33%, respectively (P < .001). On multivariate analysis, grade III-IV acute GVHD was higher in URD without ATG (P = .001), as well as URD with ATG (P = .01), relative to haploidentical transplants. Similarly, relative to haploidentical transplants, risk of chronic GVHD was higher in URD without ATG and URD with ATG (P < .0001). Cumulative incidence of relapse/progression at 3 years was 36%, 28%, and 36% in the haploidentical, URD without ATG, and URD with ATG groups, respectively (P = .07). Corresponding 3-year overall survival (OS) was 60%, 62%, and 50% in the 3 groups, respectively, with multivariate analysis showing no survival difference between URD without ATG (P = .21) or URD with ATG (P = .16), relative to haploidentical transplants. Multivariate analysis showed no difference between the 3 groups in terms of nonrelapse mortality (NRM), relapse/progression, and progression-free survival (PFS). These data suggest that reduced-intensity conditioning haploidentical transplantation with posttransplant cyclophosphamide does not compromise early survival outcomes compared with matched URD transplantation, and is associated with significantly reduced risk of chronic GVHD.
我们评估了917例成年淋巴瘤患者，这些患者在接受减低强度预处理方案后，接受了单倍体相合（n = 185）或人类白细胞抗原（HLA）匹配的无关供者（URD）移植，其中接受抗胸腺细胞球蛋白（ATG）的有241例，未接受ATG的有491例。单倍体相合移植受者接受基于移植后环磷酰胺的移植物抗宿主病（GVHD）预防，而URD移植受者接受基于钙调神经磷酸酶抑制剂的预防。存活者的中位随访时间为3年。单因素分析显示，单倍体相合、未接受ATG的URD和接受ATG的URD组中，III-IV级急性GVHD的100天累积发生率分别为8%、12%和17%（P = 0.44）。单因素分析显示，相应的1年慢性GVHD发生率分别为13%、51%和33%（P < 0.001）。多因素分析显示，与单倍体相合移植相比，未接受ATG的URD组（P = 0.001）以及接受ATG的URD组（P = 0.01）中III-IV级急性GVHD发生率更高。同样，与单倍体相合移植相比，未接受ATG的URD组和接受ATG的URD组中慢性GVHD风险更高（P < 0.0001）。单倍体相合、未接受ATG的URD和接受ATG的URD组3年时复发/进展的累积发生率分别为36%、28%和36%（P = 0.07）。相应的3组3年总生存率（OS）分别为60%、62%和50%，多因素分析显示，与单倍体相合移植相比，未接受ATG的URD组（P = 0.21）或接受ATG的URD组（P = 0.16）在生存率上无差异。多因素分析显示，3组在非复发死亡率（NRM）、复发/进展和无进展生存期（PFS）方面无差异。这些数据表明，与匹配的URD移植相比，采用移植后环磷酰胺的减低强度预处理单倍体相合移植不会影响早期生存结果，且与慢性GVHD风险显著降低相关。
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