Tsai Xavier Cheng-Hong, Chen Tzu-Ting, Gau Jyh-Pyng, Wang Po-Nan, Liu Yi-Chang, Lien Ming-Yu, Li Chi-Cheng, Yao Ming, Ko Bor-Sheng
Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan.
Genome and Systems Biology Degree Program, National Taiwan University, Taipei 10617, Taiwan.
Cancers (Basel). 2022 Feb 21;14(4):1097. doi: 10.3390/cancers14041097.
The two most noteworthy strategies for haploidentical stem cell transplantation (haplo-HSCT) are posttransplantation cyclophosphamide (PTCy) with or without thymoglobulin (ATG) and granulocyte colony stimulating factor-primed bone marrow plus peripheral blood stem cells (GIAC). We aimed to compare these approaches in patients with hematological malignancies.
We enrolled 178 patients undergoing haplo-HSCT, including modified GIAC (mGIAC), PTCy without ATG, and PTCy with ATG.
The patients in the mGIAC group had the most favorable platelet and neutrophil engraftment kinetics. Although the grade III-IV acute graft-versus-host-disease (GvHD) rates were similar, those receiving mGIAC had a significantly higher extensive chronic GvHD rate. The patients receiving mGIAC had a similar cumulative incidence of relapse (CIR) to that in the patients receiving PTCy with ATG, but this was lower than that in the patients receiving PTCy without ATG. The patients receiving mGIAC had the lowest nonrelapse mortality (NRM) and the highest overall survival (OS) rates. The differences in CIR, NRM, and OS remained significant when focusing on patients with low/intermediate-risk diseases before haplo-HSCT. Intriguingly, among patients with high/very-high-risk diseases before haplo-HSCT, no differences were observed in the CIR, NRM, OS, or GvHD/relapse-free survival.
the mGIAC approach may yield a better outcome in Taiwanese patients with hematologic malignancies, especially for those with low/intermediate-risk diseases.
单倍体相合干细胞移植（haplo-HSCT）的两种最值得注意的策略是移植后环磷酰胺（PTCy）联合或不联合抗胸腺细胞球蛋白（ATG）以及粒细胞集落刺激因子动员的骨髓加外周血干细胞（GIAC）。我们旨在比较这些方法在血液系统恶性肿瘤患者中的疗效。
我们纳入了178例接受haplo-HSCT的患者，包括改良GIAC（mGIAC）、不联合ATG的PTCy以及联合ATG的PTCy。
mGIAC组患者的血小板和中性粒细胞植入动力学最为良好。尽管III-IV级急性移植物抗宿主病（GvHD）发生率相似，但接受mGIAC的患者广泛慢性GvHD发生率显著更高。接受mGIAC的患者复发累积发生率（CIR）与接受联合ATG的PTCy的患者相似，但低于接受不联合ATG的PTCy的患者。接受mGIAC的患者非复发死亡率（NRM）最低，总生存率（OS）最高。在haplo-HSCT前关注低/中危疾病患者时，CIR、NRM和OS的差异仍然显著。有趣的是，在haplo-HSCT前高/极高危疾病患者中，CIR、NRM、OS或GvHD/无复发生存率未观察到差异。
mGIAC方法可能在台湾血液系统恶性肿瘤患者中产生更好的结果，尤其是对于低/中危疾病患者。
