降低毒性预处理方案，联合低剂量移植后环磷酰胺和低剂量抗胸腺细胞球蛋白，用于预防老年患者单倍体造血干细胞移植中的移植物抗宿主病。
Reduced-toxicity conditioning regimen with low dose post-transplantation cyclophosphamide and low-dose anti-thymocyte globulin as graft-versus-host disease prophylaxis for haploidentical stem cell transplantation in older patients.
机构信息
Department of Hematology, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, China.
Institute of Hematology, Ningbo University, Ningbo, Zhejiang, China.
出版信息
Ann Hematol. 2024 Aug;103(8):3135-3143. doi: 10.1007/s00277-024-05818-5. Epub 2024 May 29.
UNLABELLED
Reduced-toxicity conditioning (RIC) regimens are used for allogeneic hematopoietic stem cell transplantation in older patients. However, successful outcomes are hindered by graft-versus-host disease (GVHD), treatment-related mortality, and relapse, particularly after haploidentical donor hematopoietic stem cell transplantation (HID-HSCT). The aim of this study was to evaluate the effectiveness of an RIC conditioning regimen that included a combination of cyclosporin A, methotrexate (on day + 1), mycophenolate, lower doses of post-transplantation PTCy (40 mg/kg on day + 3), and ATG (7.5 mg/kg) as GVHD prophylaxis prior to haplo-stem cell transplantation (haplo-SCT) in older patients.
METHODS
We retrospectively analyzed outcomes in 55 patients ≥ 55 years of age with hematologic malignancies treated with fludarabine, cytarabine, busulfan, and low-dose cyclophosphamide as the conditioning regimen between January 1, 2019, and November 30, 2023.
RESULTS
Neutrophil engraftment was successful in all patients within 28 days, with 54 patients (98.2%) achieving complete donor chimerism. The cumulative incidence of non-relapse mortality was 0% at 30 days, 7.5% at 100 days, and 19% at 1 year. The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) was 25% (95%CI, 15-38%), whereas that of grade III-IV aGVHD was 9.1% (95% CI, 3.3-19%). The cumulative incidence of extensive chronic graft-versus-host disease at 1 year was 3.6% (95%CI, 0.66-11%). The cumulative incidences of relapse, overall survival, and GVHD-free/relapse-free survival at 1 year were 9.0%, 71.6%, and 67.1%, respectively.
CONCLUSIONS
An RIC conditioning regimen, including a combination of lower PTCy/ATG as GVHD prophylaxis, followed by haplo-SCT, might be a promising option for appropriately selected older patients.
目的
评估在异基因造血干细胞移植（allo-HSCT）前，采用环孢素 A、甲氨蝶呤（+1 天）、霉酚酸酯、较低剂量的移植后环磷酰胺（+3 天，40mg/kg）和 ATG（7.5mg/kg）作为 GVHD 预防方案的 RIC 预处理方案在老年患者中 haplo 干细胞移植（haplo-SCT）中的有效性。
方法
我们回顾性分析了 2019 年 1 月 1 日至 2023 年 11 月 30 日期间接受氟达拉滨、阿糖胞苷、白消安和低剂量环磷酰胺预处理方案治疗的 55 例年龄≥55 岁血液系统恶性肿瘤患者的结局。
结果
所有患者在 28 天内均成功获得中性粒细胞植入，54 例（98.2%）患者完全获得供者嵌合。30 天、100 天和 1 年的非复发死亡率累积发生率分别为 0%、7.5%和 19%。2 级-4 级急性移植物抗宿主病（aGVHD）累积发生率为 25%（95%CI，15-38%），3 级-4 级 aGVHD 累积发生率为 9.1%（95%CI，3.3-19%）。1 年时广泛慢性移植物抗宿主病的累积发生率为 3.6%（95%CI，0.66-11%）。1 年时的复发率、总生存率和无 GVHD/无复发生存率的累积发生率分别为 9.0%、71.6%和 67.1%。
结论
包括较低剂量 PTCy/ATG 作为 GVHD 预防方案的 RIC 预处理方案，随后进行 haplo-SCT，可能是老年患者的一种有前途的选择。
Zotero 插件