氟达拉滨和马法兰联合用药与减少剂量的白消安和氟达拉滨相比，可改善老年骨髓增生异常综合征患者的移植结局。
Fludarabine and Melphalan Compared with Reduced Doses of Busulfan and Fludarabine Improve Transplantation Outcomes in Older Patients with Myelodysplastic Syndromes.
机构信息
Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin.
出版信息
Transplant Cell Ther. 2021 Nov;27(11):921.e1-921.e10. doi: 10.1016/j.jtct.2021.08.007. Epub 2021 Aug 14.
Reduced-intensity conditioning (RIC) regimens developed to extend the use of allogeneic hematopoietic stem cell transplantation (HSCT) to older patients have resulted in encouraging outcomes. We aimed to compare the 2 most commonly used RIC regimens, i.v. fludarabine with busulfan (FluBu) and fludarabine with melphalan (FluMel), in patients with myelodysplastic syndrome (MDS). Through the Center for International Blood and Marrow Transplant Research (CIBMTR), we identified 1045 MDS patients age ≥60 years who underwent first HSCT with a matched related or matched (8/8) unrelated donor using an RIC regimen. The CIBMTR's definition of RIC was used: a regimen that incorporated an i.v. busulfan total dose ≤7.2 mg/kg or a low-dose melphalan total dose ≤150 mg/m. The 2 groups, recipients of FluBu (n = 697) and recipients of FluMel (n = 448), were comparable in terms of disease- and transplantation-related characteristics except for the more frequent use of antithymocyte globulin or alemtuzumab in the FluBu group (39% versus 31%). The median age was 67 years in both groups. FluMel was associated with a reduced relapse incidence (RI) compared with FluBu, with a 1-year adjusted incidence of 26% versus 44% (P ≤ .0001). Transplantation-related mortality (TRM) was higher in the FluMel group (26% versus 16%; P ≤ .0001). Because the magnitude of improvement with FluMel in RI was greater than the improvement in TRM with FluBu, disease-free survival (DFS) was better at 1 year and beyond with FluMel compared with FluBu (48% versus 40% at 1 year [P = .02] and 35% versus 27% at 3 years [P = .01]). Overall survival was comparable in the 2 groups at 1 year (63% versus 61%; P = .4) but was significantly improved with FluMel compared with FluBu at 3 years (46% versus 39%; P = .03). Our results suggest that FluMel is associated with superior DFS compared with FluBu owing to reduced RI in older patients with MDS patients. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
采用降低强度的预处理方案（RIC）可将异基因造血干细胞移植（HSCT）扩展至老年患者，已取得令人鼓舞的结果。我们旨在比较两种最常用的 RIC 方案，即静脉注射氟达拉滨联合白消安（FluBu）和氟达拉滨联合美法仑（FluMel），用于治疗骨髓增生异常综合征（MDS）患者。通过国际血液和骨髓移植研究中心（CIBMTR），我们鉴定了 1045 例年龄≥60 岁的 MDS 患者，他们接受了使用 RIC 方案的匹配相关或匹配（8/8）无关供者的首次 HSCT。CIBMTR 对 RIC 的定义为：静脉注射白消安总剂量≤7.2mg/kg 或低剂量美法仑总剂量≤150mg/m。FluBu 组（n=697）和 FluMel 组（n=448）在疾病和移植相关特征方面具有可比性，除了 FluBu 组更常使用抗胸腺细胞球蛋白或阿仑单抗（39%比 31%）外。两组的中位年龄均为 67 岁。与 FluBu 相比，FluMel 与较低的复发发生率（RI）相关，1 年时调整后的 RI 发生率为 26%比 44%（P≤.0001）。FluMel 组的移植相关死亡率（TRM）更高（26%比 16%；P≤.0001）。由于 FluMel 在 RI 方面的改善幅度大于 FluBu 在 TRM 方面的改善幅度，因此 FluMel 组的无病生存（DFS）在 1 年及以后优于 FluBu 组（1 年时 48%比 40%[P=.02]，3 年时 35%比 27%[P=.01]）。两组在 1 年时的总生存（OS）相当（63%比 61%；P=.4），但 FluMel 组在 3 年时明显优于 FluBu 组（46%比 39%；P=.03）。我们的结果表明，在 MDS 老年患者中，由于 RI 降低，FluMel 与 FluBu 相比，DFS 更好。 © 2021 美国移植与细胞治疗学会。由 Elsevier Inc. 出版。
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