来自半相合供体与基因相合同胞供体的造血干细胞移植治疗成人男性急性髓系白血病患者首次完全缓解：来自欧洲血液和骨髓移植学会急性白血病工作组的一项回顾性研究。
Stem cell transplantation from a haploidentical donor versus a genoidentical sister for adult male patients with acute myelogenous leukemia in first remission: A retrospective study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation.
机构信息
Department of Hematology and Cell Therapy, Saint-Antoine Hospital, Paris, France.
Institut national de la santé et de la recherche médicale (INSERM) Unit 938, Assistance Publique-Hopitaux de Paris APHP, Sorbonne University, Paris, France.
出版信息
Cancer. 2020 Mar 1;126(5):1004-1015. doi: 10.1002/cncr.32629. Epub 2019 Nov 27.
BACKGROUND
In adult patients with acute myeloid leukemia (AML), a matched sibling donor (MSD) is considered the first choice for an allogeneic transplantation. However, a female donor for a male recipient is a poor prognostic factor. The authors compared haploidentical (HAPLO) donors with female MSDs.
METHODS
In total, 834 men underwent allogenic transplantation from a female MSD, and 232 men underwent allogenic transplantation from a HAPLO donor. Of these, 86% of HAPLO recipients and 3% of MSD recipients received graft-versus-host disease (GVHD) prophylaxis posttransplantation with high-dose cyclophosphamide. A significant qualitative interaction was observed between donor type and cytogenetics, Therefore, the analyses were stratified on cytogenetics.
RESULTS
Of the men with intermediate-risk AML, 638 received transplantation from a female MSD, and 160 received transplantation from a HAPLO donor. In multivariate analysis, poor risk factors were a HAPLO donor versus an MSD for nonrelapse mortality (hazard ratio [HR], 1.7; P = .02) and patient age for nonrelapse mortality and overall survival (HR, 1.22 [P = .02] and 1.15 [P = .02], respectively). HAPLO transplantation resulted in less chronic GVHD (HR, 0.43; P < 10 ) but lower leukemia-free survival (HR, 1.7; P = .04). The GVHD/relapse-free survival (GRFS) was not different. Of the men with high-risk AML, 196 received transplantation from a female MSD, and 72 received transplantation from a HAPLO donor. By multivariate analysis, HAPLO recipients had a lower incidence of relapse (HR, 0.40; P = .004), better leukemia-free survival (HR, 0.46; P = .003), better overall survival (HR, 0.43; P = .003), and better GRFS (HR, 0.54; P = .006).
CONCLUSIONS
In men who have intermediate-risk AML, allogenic transplantation from a sister MSD or a HAPLO donor produces similar GRFS. However, in men who have high-risk AML, a HAPLO donor combined with prophylactic high-dose cyclophosphamide posttransplantation may be a better choice.
背景
在急性髓系白血病（AML）的成年患者中，匹配的同胞供体（MSD）被认为是异体移植的首选。然而，女性供体给男性受者是一个预后不良的因素。作者比较了单倍体相合（HAPLO）供体和女性 MSD。
方法
共有 834 名男性接受了女性 MSD 的同种异体移植，232 名男性接受了 HAPLO 供体的同种异体移植。其中，86%的 HAPLO 受者和 3%的 MSD 受者在移植后接受了高剂量环磷酰胺预防移植物抗宿主病（GVHD）。观察到供体类型和细胞遗传学之间存在显著的定性相互作用，因此，根据细胞遗传学对分析进行了分层。
结果
在中危 AML 男性中，638 名接受了女性 MSD 的移植，160 名接受了 HAPLO 供体的移植。多变量分析显示，非复发死亡率的高危因素是 HAPLO 供体而非 MSD（危险比 [HR]，1.7；P=0.02）和患者年龄与非复发死亡率和总生存率（HR，1.22[P=0.02]和 1.15[P=0.02]）相关。HAPLO 移植导致慢性 GVHD 发生率较低（HR，0.43；P<10），但白血病无复发生存率较低（HR，1.7；P=0.04）。GVHD/无复发生存率（GRFS）无差异。在高危 AML 男性中，196 名接受了女性 MSD 的移植，72 名接受了 HAPLO 供体的移植。多变量分析显示，HAPLO 受者复发率较低（HR，0.40；P=0.004），白血病无复发生存率较好（HR，0.46；P=0.003），总生存率较好（HR，0.43；P=0.003），GRFS 较好（HR，0.54；P=0.006）。
结论
在中危 AML 男性中，来自姐妹 MSD 或 HAPLO 供体的同种异体移植产生相似的 GRFS。然而，在高危 AML 男性中，HAPLO 供体联合移植后预防性使用高剂量环磷酰胺可能是更好的选择。
Zotero 插件