德国采用PT-CY的单倍体移植与采用抗胸腺细胞球蛋白的10/10全相合无关供者移植的结果。

Outcomes of haploidentical transplants with PT-CY vs 10/10 MUD transplants with ATG in Germany.

作者信息

Arslan Aysenur, Labuhn Svenja, Sala Elisa, Ringhoffer Mark, Schetelig Johannes, Schröder Thomas, Bug Gesine, Franke Georg-Nikolaus, Stelljes Matthias, Dreger Peter, Zeiser Robert, Teschner Daniel, Bethge Wolfgang, Eder Matthias, Edinger Matthias, Amann Elisa Maria, Neuchel Christine, Schmid-Möglich Amelie, Schmeller Sandra, Beyersmann Jan, Schrezenmeier Hubert, Mytilineos Joannis, Kröger Nicolaus, Fürst Daniel

机构信息

Department of Transplantation Immunology, Institute of Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Transfusion Service, Baden Wuerttemberg - Hessen, University Hospital Ulm, Ulm, Germany.

Department of Transplantation Immunology, Institute of Transfusion Medicine, University of Ulm, Ulm, Germany.

出版信息

Blood Adv. 2024 Dec 10;8(23):6104-6113. doi: 10.1182/bloodadvances.2024013719.

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the best curative treatment modality for many malignant hematologic disorders. In the absence of a matched related donor, matched unrelated donors (MUDs) and haploidentical donors are the most important stem cell sources. In this registry-based retrospective study, we compared the outcomes of allo-HSCTs from 10/10 MUDs with antithymocyte globulin (ATG)-based regimens (n = 7050) vs haploidentical transplants (Haplo-Tx) using posttransplant cyclophosphamide (PT-CY Haplo; n = 487) in adult patients with hematologic malignancies between 2010 and 2020. Cox proportional hazard-and competing risks regression models were formed to compare the outcomes. Overall survival (OS), Disease-free survival (DFS), and graft-versus-host disease (GVHD)-free and relapse-free survival (GRFS) were superior for 10/10 MUDs (OS [hazard ratio (HR), 1.27; 95% confidence interval (CI), 1.10-1.47; P = .001]; DFS [HR, 1.17; CI, 1.02-1.34; P = .022]; GRFS [HR, 1.34; CI, 1.19-1.50; P < .001]). The risk of acute GVHD (aGVHD) grade 2 to 4, aGVHD grade 3 to 4, and chronic GVHD (cGVHD) was higher in the PT-CY Haplo group than the 10/10 MUD group (aGVHD grade 2-4 [HR, 1.46; CI, 1.25-1.71; P < .001]; aGVHD grade 3-4 [HR, 1.74; CI, 1.37- 2.20; P < .001]; cGVHD [HR, 1.30; CI, 1.11-1.51; P = .001]). A lower incidence of relapse was observed in the PT-CY Haplo group (relapse: HR, 0.83; CI, 0.69-0.99; P = .038). Unrelated 10/10 matched transplantation with ATG leads to lower GVHD rates and improved survival rates compared with PT-CY Haplo transplantation in Germany.

异基因造血干细胞移植（allo-HSCT）是许多恶性血液系统疾病的最佳治愈性治疗方式。在缺乏匹配的亲属供者时，匹配的非亲属供者（MUDs）和单倍型相合供者是最重要的干细胞来源。在这项基于登记处的回顾性研究中，我们比较了2010年至2020年间，采用基于抗胸腺细胞球蛋白（ATG）方案的10/10 MUDs异基因造血干细胞移植（n = 7050）与使用移植后环磷酰胺的单倍型相合移植（PT-CY Haplo；n = 487）治疗成年血液系统恶性肿瘤患者的疗效。构建Cox比例风险和竞争风险回归模型以比较疗效。10/10 MUDs组的总生存期（OS）、无病生存期（DFS）以及无移植物抗宿主病（GVHD）和无复发生存期（GRFS）更优（OS [风险比（HR），1.27；95%置信区间（CI），1.10 - 1.47；P = 0.001]；DFS [HR，1.17；CI，1.02 - 1.34；P = 0.022]；GRFS [HR，1.34；CI，1.19 - 1.50；P < 0.001]）。PT-CY Haplo组2至4级急性GVHD（aGVHD）、3至4级aGVHD和慢性GVHD（cGVHD）的风险高于10/10 MUD组（2 - 4级aGVHD [HR，1.46；CI，1.25 - 1.71；P < 0.001]；3 - 4级aGVHD [HR，1.74；CI，1.37 - 2.20；P < 0.001]；cGVHD [HR，1.30；CI，1.11 - 1.51；P = 0.001]）。PT-CY Haplo组的复发率较低（复发：HR，0.83；CI，0.69 - 0.99；P = 0.038）。在德国，与PT-CY Haplo移植相比，采用ATG的10/10非亲属匹配移植导致GVHD发生率更低且生存率更高。