Nakamura Y, Tanaka Y, Tanaka M, Yamamoto K, Matsuguma M, Kajimura Y, Tokunaga Y, Yujiri T, Tanizawa Y
Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube, Yamaguchi, Japan.
Transplant Proc. 2019 Apr;51(3):896-900. doi: 10.1016/j.transproceed.2019.01.079. Epub 2019 Jan 31.
Allogeneic hematopoietic cell transplant (HCT) is a curative procedure for myeloid malignant neoplasms, but relapse after HCT remains critical. A conditioning regimen involving granulocyte colony-stimulating factor-combined high-dose cytarabine, cyclophosphamide, and total body irradiation (G-CSF-combined high-dose cytarabine/cyclophosphamide/total-body irradiation [HDCA/CY/TBI]) was reported to improve outcomes after cord blood transplant (CBT) for myeloid malignant neoplasms, but this regimen was not previously evaluated among patients undergoing bone marrow transplant (BMT) or peripheral blood stem cell transplant (PBSCT).
We retrospectively analyzed 28 patients who underwent allogeneic HCT including BMT from a related (1 patient) or unrelated donor (9 patients), PBSCT from a related donor (7 patients), or single-unit CBT from an unrelated donor (11 patients) after a G-CSF-combined HDCA/CY/TBI regimen.
All patients achieved neutrophil and platelet engraftment, which were significantly more rapid in the BMT/PBSCT group than in the CBT group. Eighteen patients were alive at a median follow-up of 54.3 months. The 3-year relapse and nonrelapse mortality rates were 28.6% and 7.1%, respectively, which were similar between the BMT/PBSCT and CBT groups. Overall survival and disease-free survival at 5 years after HCT were 62.6% and 64.3%, respectively, which were also similar between the BMT/PBSCT and CBT groups. Only disease status at HCT had a significant impact on overall survival and disease-free survival (86.7% with standard risk vs 38.5% with high risk and 86.7% with standard risk vs 38.5% with high risk, respectively).
A G-CSF-combined HDCA/CY/TBI regimen is a promising conditioning in patients with myeloid malignant neoplasms who undergo not only CBT but also BMT or PBSCT.
异基因造血细胞移植（HCT）是治疗髓系恶性肿瘤的一种根治性方法，但HCT后的复发仍然是关键问题。据报道，一种包含粒细胞集落刺激因子联合大剂量阿糖胞苷、环磷酰胺和全身照射（G-CSF联合大剂量阿糖胞苷/环磷酰胺/全身照射[HDCA/CY/TBI]）的预处理方案可改善髓系恶性肿瘤脐带血移植（CBT）后的预后，但该方案此前未在接受骨髓移植（BMT）或外周血干细胞移植（PBSCT）的患者中进行评估。
我们回顾性分析了28例接受异基因HCT的患者，这些患者在接受G-CSF联合HDCA/CY/TBI方案后，接受了来自相关供体（1例）或无关供体的BMT（9例）、来自相关供体的PBSCT（7例）或来自无关供体的单单位CBT（11例）。
所有患者均实现了中性粒细胞和血小板植入，BMT/PBSCT组的植入速度明显快于CBT组。在中位随访54.3个月时，18例患者存活。3年复发率和非复发死亡率分别为28.6%和7.1%，BMT/PBSCT组和CBT组相似。HCT后5年的总生存率和无病生存率分别为62.6%和64.3%，BMT/PBSCT组和CBT组也相似。只有HCT时的疾病状态对总生存率和无病生存率有显著影响（标准风险组分别为86.7%和高风险组为38.5%，标准风险组分别为86.7%和高风险组为38.5%）。
G-CSF联合HDCA/CY/TBI方案对于不仅接受CBT，而且接受BMT或PBSCT的髓系恶性肿瘤患者是一种有前景的预处理方案。
