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首例单倍体造血干细胞移植(HAPLO-SCT1)后复发的再次单倍体造血干细胞移植(HAPLO-SCT2):一项代表欧洲血液和骨髓移植学会(EBMT)急性白血病工作组(ALWP)的研究。

Second haploidentical stem cell transplantation (HAPLO-SCT2) after relapse from a first HAPLO-SCT in acute leukaemia-a study on behalf of the Acute Leukaemia Working Party (ALWP) of the European Society for Blood and Marrow Transplantation (EBMT).

机构信息

Section for Stem Cell Transplantation, Augsburg University Hospital and Medical Faculty, Augsburg, Germany.

EBMT Paris Study Unit, Saint-Antoine Hospital, Paris, France.

出版信息

Bone Marrow Transplant. 2023 Aug;58(8):907-915. doi: 10.1038/s41409-023-01985-7. Epub 2023 May 9.

Abstract

For patients with acute myeloid and lymphoblastic leukaemia (AML/ALL) lacking a matched sibling or unrelated donor, haploidentical stem cell transplantation (HAPLO-SCT) is increasingly used. However, available data on the treatment of relapse after HAPLO-SCT, including feasibility and efficacy of a second HAPLO-SCT (HAPLO-SCT2), is scarce. Hence, adults with AML/ALL, that had undergone HAPLO-SCT2 without ex-vivo manipulation after haematologic relapse from HAPLO-SCT1 were selected for a retrospective registry analysis. Eighty-two patients (AML, n = 63, ALL, n = 19, median follow-up: 33 months) were identified. Engraftment rate was 87%. At day +180, cumulative incidences of acute GvHD II-IV°/chronic GvHD were 23.9%/22.6%, respectively. Two-year overall survival/leukaemia-free survival (OS/LFS) were 34.3%/25.4%; 2-year non-relapse mortality (NRM) and relapse incidence (RI) were 17.6% and 57%. Leukaemia was the most frequent cause of death. Separated by disease, 2-year OS/LFS/NRM/RI were 28.7%/22.3%/16.2%/61.6% in AML, and 55.3%/38.4%/23.5%/38.2% in ALL patients. In a risk-factor analysis among patients with AML, stage at HAPLO-SCT1 and HAPLO-SCT2, and interval from HAPLO-SCT1 to relapse significantly influenced outcome. Our data demonstrate that HAPLO-SCT2 is a viable option in acute leukaemia relapse after HAPLO-SCT1. Engraftment, toxicity, risk factors and long-term outcome are comparable to data reported after allo-SCT2 in a matched donor setting.

摘要

对于缺乏匹配的同胞供体或无关供体的急性髓系和淋巴母细胞白血病(AML/ALL)患者,越来越多地使用单倍体造血干细胞移植(haploidentical stem cell transplantation,HAPLO-SCT)。然而,关于 HAPLO-SCT 后复发的治疗,包括第二次 HAPLO-SCT(HAPLO-SCT2)的可行性和疗效的数据很少。因此,选择了在 HAPLO-SCT1 后因血液学复发而未经体外操作进行 HAPLO-SCT2 的 AML/ALL 成年患者进行回顾性登记分析。确定了 82 例患者(AML,n=63,ALL,n=19,中位随访时间:33 个月)。植入率为 87%。在+180 天,急性 GvHD II-IV°/慢性 GvHD 的累积发生率分别为 23.9%/22.6%。2 年总生存率/无白血病生存率(OS/LFS)分别为 34.3%/25.4%;2 年非复发死亡率(NRM)和复发率(RI)分别为 17.6%和 57%。白血病是最常见的死亡原因。按疾病分组,AML 的 2 年 OS/LFS/NRM/RI 分别为 28.7%/22.3%/16.2%/61.6%,ALL 患者分别为 55.3%/38.4%/23.5%/38.2%。在 AML 患者的风险因素分析中,HAPLO-SCT1 和 HAPLO-SCT2 时的分期、HAPLO-SCT1 至复发的时间间隔显著影响结果。我们的数据表明,HAPLO-SCT2 是 HAPLO-SCT1 后急性白血病复发的可行选择。植入、毒性、危险因素和长期结果与在匹配供体环境中进行 allo-SCT2 后报告的数据相当。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f0b2/10400422/2bf6074760c4/41409_2023_1985_Fig1_HTML.jpg

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