Efficacy and Safety of Unmanipulated Haploidentical Related Donor Allogeneic Peripheral Blood Stem Cell Transplantation in Patients with Relapsed/Refractory Acute Myeloid Leukemia.
Efficacy and Safety of Unmanipulated Haploidentical Related Donor Allogeneic Peripheral Blood Stem Cell Transplantation in Patients with Relapsed/Refractory Acute Myeloid Leukemia.
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DOI：
10.4103/0366-6999.228243
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发表时间：
2018-04-05
影响因子：
6.1
通讯作者：
Liu DH
中科院分区：
文献类型：
--
作者：
Dou LP;Li HH;Wang L;Li F;Huang WR;Yu L;Liu DH
使用外周血干细胞（PBSC）和骨髓的组合作为移植物的单倍性相关供体（HRD）干细胞移植的研究报告了血液病患者的令人鼓舞的结果。然而，很少有研究专门报道在复发性或难治性急性髓性白血病（AML）患者中仅移植HRD的PBSC。本文分析了未经操作的HRD PBSC移植（HRD-PBSCT）治疗复发/难治性AML的长期结局和副作用。我们对接受HRD PBSCT的复发/难治性AML患者（n = 36）的结局进行了回顾性分析。HRD-PBSCT组31例（86.1%）患者实现血小板恢复。HRD-PBSCT组急性移植物抗宿主病（aGVHD）的累积发生率为40.00%，2-4级aGVHD的累积发生率为13.33%。HRD-PBSCT组中共有13例患者在移植后中位数183天（范围：10-1700天）时复发，5年时累积复发率为50.28%。多因素分析显示，供者年龄和患者年龄>40岁是无病生存期或总生存期较差的独立危险因素（P < 0.05）。本研究的结果表明，HRD-PBSCT后患者的中性粒细胞植入迅速而完全，2-4级aGVHD的发生率低，存活率有希望。因此，粒细胞集落刺激因子致敏的外周血干细胞可能是一个可靠的移植物来源，在未经操作的HRD-HSCT清髓性条件下，没有匹配的同胞供体。我们的研究结果支持PBSC作为白血病患者清髓性预处理下未经操作的HRD移植的移植物来源的可行性、有效性和耐受性。
Studies of haploidentical-related donor (HRD) stem cell transplantation using a combination of peripheral blood stem cells (PBSCs) and bone marrow as the graft have reported encouraging results for patients with hematological diseases. However, few studies specifically reported transplantation of only PBSCs from HRDs among patients with relapsed or refractory acute myeloid leukemia (AML). Here, the long-term outcomes and side effects of unmanipulated HRD PBSC transplantation (HRD-PBSCT) for relapsed/refractory AML were analyzed. We performed a retrospective analysis of the outcomes in relapsed/refractory AML patients who underwent PBSCT from HRDs (n = 36). Thirty-one (86.1%) patients in the HRD-PBSCT group achieved platelet recovery. The cumulative incidence of acute graft-versus-host disease (aGVHD) in the HRD-PBSCT group was 40.00%, and the cumulative incidence of grades 2–4 aGVHD in this group was 13.33%. A total of 13 patients in the HRD-PBSCT group had recurrent disease at a median of 183 days after transplantation (range: 10–1700 days), reaching cumulative incidences of relapse of 50.28% at 5 years. On multivariate analysis, donor age and patient age >40 years were independent risk factors for inferior disease-free survival or overall survival (P < 0.05). The results of the present study demonstrate rapid and complete neutrophil engraftment, a low incidence of grade 2–4 aGVHD, and promising survival rates in patients after HRD-PBSCT. Thus, granulocyte colony-stimulating factor–primed PBSCs may be a reliable graft source in unmanipulated HRD-HSCT under myeloablative conditioning when no matched sibling donor is available. Our results support the feasibility, effectiveness, and tolerability of PBSCs as a graft source in unmanipulated HRD transplantation under myeloablative conditioning in patients with leukemia.