Use of partially mismatched related donors extends access to allogeneic marrow transplant
Use of partially mismatched related donors extends access to allogeneic marrow transplant
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DOI：
10.1182/blood.v89.10.3864.3864_3864_3872
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发表时间：
1997-05-15
期刊：
影响因子：
20.3
通讯作者：
Gee, AP
中科院分区：
文献类型：
--
作者：
HensleeDowney, PJ;Abhyankar, SH;Gee, AP
大多数需要异基因骨髓移植（allo-BMT）的患者没有HLA匹配的同胞供体。表型匹配的无关供体移植已经为大约50%的白人和不到10%的少数民族和种族提供了需要。然而，几乎所有的患者都有现成的部分不匹配的相关供体（PMRD）。我们总结了72例患者的经验，这些患者的年龄范围为1至50岁（中位数为16岁），接受了来自单倍体相合家庭成员的PMRD allo-BMT，接受了全身照射（TBI）和多药高剂量化疗的预处理治疗。联合T细胞耗竭和骨髓移植后免疫抑制预防移植物抗宿主病（GVHD）。第32天时的植入概率为0.88。10例植入失败的患者中有6例在二次移植后实现了植入。在58例可评价患者中有9例（16%）观察到II级至IV级急性GVHD;在48例可评价患者中有4例（8%）观察到广泛慢性GVHD。低风险和高风险患者的2年生存率差异有统计学意义（0.55 v0.27，P = 0.048）。多因素分析中影响预后的因素有：（1）TBI剂量较低和3抗原排斥不匹配降低稳定植入（P = .005和P = .002）;（2）较高的T细胞剂量增加急性GVHD（P = 0.058）;（3）较高的TBI剂量增加慢性GVHD（P = 0.16）;（4）高风险疾病类别增加复发或死亡的治疗失败（P = 0.037）。PMRD移植可以以可接受的移植物失败率和GVHD进行。使用序贯免疫调节，移植时的疾病状态是唯一与PMRD allo-BMT后长期成功结局显著相关的预后因素。当适应症为同种异体而非自体BMT时，使用PMRD可避免移植前疾病状态的进展，并平等纳入所有种族或人种组。(C)1997年，美国血液学会。
Most patients requiring allogeneic bone marrow transplant (allo-BMT) do not have an HLA-matched sibling donor. A phenotypically matched unrelated donor graft has been made available for approximately 50% of Caucasians and less than 10% of ethnic and racial minorities in need. However, almost all patients have a readily available partially mismatched related donor (PMRD). We summarize our experience with 72 patients who ranged from 1 to 50 years of age (median, 16 years) and who were recipients of a PMRD allo-BMT from haploidentical family members following conditioning therapy using total body irradiation (TBI) and multiagent, high-dose chemotherapy. T-cell depletion and post-BMT immunosuppression were combined for graft-versus-host disease (GVHD) prophylaxis. The probability of engraftment was 0.88 at 32 days. Six of 10 patients who failed to engraft achieved engraftment after Secondary transplant. Grade II to IV acute GVHD was seen in 9 of 58 (16%) evaluable patients; extensive chronic GVHD was seen in 4 of 48 (8%) evaluable patients. There was a statistically significant difference in 2-year survival probability between low-risk and high-risk patients (0.55 v 0.27, P = .048). Prognostic factors that affected outcomes in multivariate analysis were (1) a lower TBI dose and 3-antigen rejection mismatch decreased stable engraftment (P = .005 and P = .002, respectively); (2) a higher T-cell dose increased acute GVHD (P = .058); (3) a higher TBI dose increased chronic GVHD (P = 0.16); and (4) a high-risk disease category increased treatment failure from relapse or death (P = .037). A PMRD transplant can be performed with acceptable rates of graft failure and GVHD. Using sequential immunomodulation, the disease status at the time of transplant is the only prognostic factor significantly associated with long-term successful outcome after PMRD allo-BMT. When allogeneic rather than autologous BMT is indicated, progression in disease status before transplant can be avoided using a PMRD with equal inclusion of all ethnic or racial groups. (C) 1997 by The American Society of Hematology.