非亲缘一级相关和一级亲缘供者单倍体造血细胞移植治疗完全缓解的急性白血病患者的相似结局：来自欧洲血液和骨髓移植学会全球委员会和急性白血病工作组的研究。
Similar outcomes following non-first-degree and first-degree related donor haploidentical hematopoietic cell transplantation for acute leukemia patients in complete remission: a study from the Global Committee and the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
机构信息
Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, China.
EBMT Global Committee (Shanghai and Paris Offices) and Acute Leukemia Working Party, Hospital Saint-Antoine APHP and Sorbonne University, Paris, France.
出版信息
J Hematol Oncol. 2023 Mar 18;16(1):25. doi: 10.1186/s13045-023-01421-9.
There are situations where non-first-degree (NFD) related donors have to be considered as alternatives to first-degree (FD) related donors for haploidentical hematopoietic cell transplantation (HAPLO). However, the efficacy of these NFD related transplants remains uncertain. All consecutive adult patients (≥ 18 years) with acute myelogenous leukemia (AML) or acute lymphocytic leukemia (ALL) in CR who underwent a first HAPLO between 2010 and 2021 in the European Society for Blood and Marrow Transplantation (EBMT) registry were analyzed. Exact matching and propensity score matching was used. The NFD-to-FD ratio was 1:3. 2703 patients (AML: n = 2047; ALL: n = 656) in CR received a first HAPLO from either NFD (n = 154) or FD (n = 2549) related donors in 177 EBMT centers. 123 NFD and 324 FD HAPLO were included for analysis after matching. Median patient age was 35.6 and 37.2 for the NFD and FD cohorts, respectively. Both cohorts reached good engraftment rates (NFD: 95.7% vs. FD, 95.6%; p = 0.78). The 2-year relapse incidence (NFD, 21.1% vs. FD, 22.6%; p = 0.84) and non-relapse mortality (NRM) (NFD, 13.2% vs. FD, 17.7%; p = 0.33) were not significantly different. The 2-year overall survival (OS) (NFD, 71.8% vs. FD, 68.3%; p = 0.56), leukemia-free survival (LFS) (NFD, 65.7% vs. FD, 59.7%; p = 0.6) and graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) (NFD, 50.9% vs. FD, 47.8%; p = 0.69) also showed no significant differences. The two cohorts showed no difference in terms of cumulative day 180 grade II-IV, grade III-IV acute GVHD, 2-year cumulative incidences of chronic and extensive chronic GVHD. For HAPLO in patients with acute leukemia, NFD related donors could be equivalent substitutions when FD related donors are not available.
在某些情况下，非亲缘（NFD）供者不得不被视为亲缘（FD）供者的替代选择，用于单倍体造血细胞移植（HAPLO）。然而，这些 NFD 相关移植的疗效仍然不确定。本研究分析了 2010 年至 2021 年间在欧洲血液和骨髓移植学会（EBMT）登记处接受首次 HAPLO 的连续成人患者（≥18 岁），这些患者患有急性髓性白血病（AML）或急性淋巴细胞白血病（ALL），处于完全缓解（CR）状态。使用精确匹配和倾向评分匹配。NFD 与 FD 的比例为 1:3。177 个 EBMT 中心的 2703 例（AML：n=2047；ALL：n=656）CR 患者接受了来自 NFD（n=154）或 FD（n=2549）相关供者的首次 HAPLO。123 例 NFD 和 324 例 FD HAPLO 在匹配后被纳入分析。NFD 队列和 FD 队列的中位患者年龄分别为 35.6 岁和 37.2 岁。两组均达到良好的植入率（NFD：95.7%vs.FD，95.6%；p=0.78）。2 年复发率（NFD，21.1%vs.FD，22.6%；p=0.84）和非复发死亡率（NRM）（NFD，13.2%vs.FD，17.7%；p=0.33）无显著差异。2 年总生存率（OS）（NFD，71.8%vs.FD，68.3%；p=0.56）、无白血病生存率（LFS）（NFD，65.7%vs.FD，59.7%；p=0.6）和移植物抗宿主病（GVHD）-无、无复发存活率（GRFS）（NFD，50.9%vs.FD，47.8%；p=0.69）也无显著差异。两组在第 180 天累积 2 级-4 级、3 级-4 级急性 GVHD、2 年累积慢性和广泛慢性 GVHD发生率方面无差异。对于急性白血病患者的 HAPLO，当 FD 相关供者不可用时，NFD 相关供者可以作为等效替代。
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