Muranushi Hiroyuki, Shindo Takero, Hishizawa Masakatsu, Tokunaga Masahito, Wake Atsushi, Nakano Nobuaki, Eto Tetsuya, Hidaka Michihiro, Choi Ilseung, Miyamoto Toshihiro, Uchida Naoyuki, Moriuchi Yukiyoshi, Miyazaki Yasuhiko, Fukuda Takahiro, Ichinohe Tatsuo, Atsuta Yoshiko, Kato Koji
Department of Hematology/Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Hematology, Imamura General Hospital, Kagoshima, Japan.
Bone Marrow Transplant. 2021 Jan;56(1):155-166. doi: 10.1038/s41409-020-00996-y. Epub 2020 Jul 14.
The outcome of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for adult T-cell leukemia/lymphoma (ATL) is still unsatisfactory. To illustrate the advantages and disadvantages of each donor source, we performed a nationwide retrospective study of graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) of patients with allo-HSCT-treated ATL. One-year GRFS did not significantly differ between patients who received related bone marrow transplantation (R-BMT; 26%, n = 117), related peripheral blood stem cell transplantation (R-PBSCT; 22%, n = 225), unrelated bone marrow transplantation (UR-BMT; 26%, n = 619), and cord blood transplantation (CBT; 21%, n = 359; p = 0.09). This was attributable to a low incidence of systemically-treated chronic GVHD after CBT (9% at 1 year) and reduced non-GVHD/relapse mortality after R-PBSCT (9% at 1 year). Among patients transplanted in complete remission (CR), 1-year overall survival after CBT (52%, n = 132) was not inferior to that after R-BMT (55%, n = 51), R-PBSCT (57%, n = 79), and UR-BMT (58%, n = 280; p = 0.15), and relapse rates were equivalent among the four sources (p = 0.19). Our results suggest that all donor sources are feasible for CR patients and that GRFS provides important clues toward optimizing allo-HSCT for ATL.
异基因造血干细胞移植（allo-HSCT）治疗成人T细胞白血病/淋巴瘤（ATL）的疗效仍不尽人意。为阐明各供体来源的优缺点，我们开展了一项全国性回顾性研究，分析接受allo-HSCT治疗的ATL患者的无移植物抗宿主病（GVHD）、无复发生存率（GRFS）。接受亲缘骨髓移植（R-BMT；26%，n = 117）、亲缘外周血干细胞移植（R-PBSCT；22%，n = 225）、非亲缘骨髓移植（UR-BMT；26%，n = 619）和脐血移植（CBT；21%，n = 359；p = 0.09）的患者，其1年GRFS无显著差异。这归因于CBT后系统性治疗的慢性GVHD发生率较低（1年时为9%）以及R-PBSCT后非GVHD/复发死亡率降低（1年时为9%）。在完全缓解（CR）状态下接受移植的患者中，CBT后的1年总生存率（52%，n = 132）不低于R-BMT（55%，n = 51）、R-PBSCT（57%，n = 79）和UR-BMT（58%，n = 280；p = 0.15），且四种供体来源的复发率相当（p = 0.19）。我们的结果表明，所有供体来源对CR患者均可行，且GRFS为优化ATL的allo-HSCT提供了重要线索。
