Hematology Department, Federico II University of Naples, Naples, Italy; Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy.
European Society for Blood and Marrow Transplantation study office, Paris, France; Hematology Department, Transplantation and Cellular Therapy Service, Hôpital Saint Antoine, Paris, France; St Antoine Research Center, INSERM Sorbonne University CRSA, Hopital St Antoine, Paris, France.
Transplant Cell Ther. 2022 Sep;28(9):587.e1-587.e7. doi: 10.1016/j.jtct.2022.06.006. Epub 2022 Jun 14.
The use of haploidentical hematopoietic cell transplantation (haplo-HCT) with peripheral blood stem cells (PBSCs) to treat acute myelogenous leukemia (AML) is increasing. We explored whether the addition of antithymocyte globulin (ATG) to post-transplantation cyclophosphamide (PTCy) allows better outcomes compared with PTCy alone in haplo-HCT with PBSCs (haplo-PBSCT). We included 441 adult patients undergoing a first haplo-PBSCT for AML in first or second complete remission; graft-versus-host disease (GVHD) prophylaxis contained either PTCy alone (n = 374) or ATG plus PTCy (n = 67), in addition to cyclosporine A (CsA) and mycophenolate mofetil (MMF) as other immunosuppressive agents. All transplantations were performed between 2011 and 2019. No major imbalances were observed between the 2 groups. For both groups, the median patient age was 56 years, and the median year of haplo-PBSCT was 2017. Most patients received a reduced-intensity conditioning regimen (57% in the PTCy group and 61% in the ATG+PTCy group; P = .54). The median follow-up was 19 months in the PTCy group versus 15 months in the ATG+PTCy group (P = .59), and the rate of neutrophil engraftment in the 2 groups was 97% and 98%, respectively. In univariate analysis, there were no statistical differences in transplantation outcomes between the 2 groups. In multivariate analysis, ATG+PTCy was associated with a lower risk of chronic GVHD compared with PTCy alone (hazard ratio, .46; 95% confidence interval, .23 to .93; P = .03). No between-group differences in the other transplantation outcomes were seen. In haplo-PBSCT, the addition of ATG to PTCy (with CsA and MMF) is feasible and better at preventing chronic GVHD and is associated with survival and transplantation outcomes comparable to those with PTCy alone, without increasing transplantation toxicity, mortality, or relapse incidence.
越来越多的人使用单倍体造血细胞移植（haplo-HCT）联合外周血干细胞（PBSCs）治疗急性髓细胞白血病（AML）。我们探索了在haplo-HCT 联合 PBSCs（haplo-PBSCT）中，与单独使用 post-transplantation cyclophosphamide（PTCy）相比，添加抗胸腺细胞球蛋白（ATG）是否能带来更好的结果。我们纳入了 441 例接受首次 haplo-PBSCT 治疗 AML 处于首次或第二次完全缓解的成年患者；移植物抗宿主病（GVHD）预防方案包含单独使用 PTCy（n=374）或 ATG 加 PTCy（n=67），此外还有环孢素 A（CsA）和吗替麦考酚酯（MMF）作为其他免疫抑制剂。所有移植均在 2011 年至 2019 年期间进行。两组之间未观察到主要的不平衡。两组患者的中位年龄均为 56 岁，中位 haplo-PBSCT 年份均为 2017 年。大多数患者接受了强度降低的预处理方案（PTCy 组 57%，ATG+PTCy 组 61%；P=0.54）。PTCy 组的中位随访时间为 19 个月，ATG+PTCy 组为 15 个月（P=0.59），两组的中性粒细胞植入率分别为 97%和 98%。单变量分析显示，两组间移植结果无统计学差异。多变量分析显示，与单独使用 PTCy 相比，ATG+PTCy 与较低的慢性 GVHD 风险相关（风险比，0.46；95%置信区间，0.23 至 0.93；P=0.03）。两组间其他移植结果无差异。在 haplo-PBSCT 中，将 ATG 加入到 PTCy（联合 CsA 和 MMF）中是可行的，并且能更好地预防慢性 GVHD，与单独使用 PTCy 相比，生存和移植结果相当，不会增加移植毒性、死亡率或复发率。
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