Yoshimitsu Makoto, Tanaka Takashi, Nakano Nobuaki, Kato Koji, Muranushi Hiroyuki, Tokunaga Masahito, Ito Ayumu, Ishikawa Jun, Eto Tetsuya, Morishima Satoko, Kawakita Toshiro, Itonaga Hidehiro, Uchida Naoyuki, Tanaka Masatsugu, Akizuki Keiichi, Ishitsuka Kenji, Ohigashi Hiroyuki, Ota Shuichi, Ando Toshihiko, Kanda Yoshinobu, Fukuda Takahiro, Atsuta Yoshiko, Fuji Shigeo
Department of Hematology and Rheumatology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Br J Haematol. 2025 Jan;206(1):235-249. doi: 10.1111/bjh.19835. Epub 2024 Oct 19.
This study retrospectively compared outcomes of various allogeneic haematopoietic cell transplantation (allo-HCT) platforms in patients with adult T-cell leukaemia/lymphoma. Platforms included human leukocyte antigen (HLA)-haploidentical-related donors using post-transplant cyclophosphamide (PTCY), HLA-matched related donors (MRD), HLA-matched unrelated donors (MUD) and cord blood transplantation (CBT). Patients who underwent their first allo-HCT between 2016 and 2021 were included. Outcomes analysed were overall survival (OS), relapse and non-relapse mortality (NRM). Seven hundred patients were included (PTCY, n = 121; MRD, n = 91; MUD, n = 160; CBT, n = 328). With a median follow-up of 794 days for survivors, 2-year OS was 48.1% (PTCY), 48.8% (MRD), 48.4% (MUD) and 34.6% (CBT); the respective 2-year cumulative incidence of relapse was 37.1%, 47.5%, 33.9% and 45.1% and that of NRM was 24.2%, 19.8%, 24.7% and 27.3%. PTCY was associated with delayed platelet engraftment relative to MRD and MUD. There was no increase in the incidence of severe acute or chronic graft-versus-host disease. In the PTCY group, poor performance status was a significant predictor of inferior OS, and infused CD34+ cell numbers of less than 5 × 10/kg were associated with delayed neutrophil and platelet engraftment. These results suggest that allo-HCT with PTCY is a safe and effective platform for patients with adult T-cell leukaemia/lymphoma.
本研究回顾性比较了成人T细胞白血病/淋巴瘤患者接受各种异基因造血细胞移植（allo-HCT）平台后的结局。这些平台包括使用移植后环磷酰胺（PTCY）的人类白细胞抗原（HLA）单倍型相合相关供者、HLA匹配的相关供者（MRD）、HLA匹配的无关供者（MUD）和脐血移植（CBT）。纳入了2016年至2021年间接受首次allo-HCT的患者。分析的结局指标为总生存期（OS）、复发率和非复发死亡率（NRM）。共纳入700例患者（PTCY组121例；MRD组91例；MUD组160例；CBT组328例）。幸存者的中位随访时间为794天，2年总生存率分别为48.1%（PTCY组）、48.8%（MRD组）、48.4%（MUD组）和34.6%（CBT组）；2年累积复发率分别为37.1%、47.5%、33.9%和45.1%，NRM分别为24.2%、19.8%、24.7%和27.3%。与MRD组和MUD组相比，PTCY组血小板植入延迟。严重急性或慢性移植物抗宿主病的发生率没有增加。在PTCY组中，体能状态差是总生存期较差的重要预测因素，输注的CD34+细胞数低于5×10⁶/kg与中性粒细胞和血小板植入延迟有关。这些结果表明，对于成人T细胞白血病/淋巴瘤患者，采用PTCY的allo-HCT是一个安全有效的平台。
