Limiting transplantation-related mortality following unrelated donor stem cell transplantation by using a nonmyeloablative conditioning regimen
Limiting transplantation-related mortality following unrelated donor stem cell transplantation by using a nonmyeloablative conditioning regimen
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DOI：
10.1182/blood.v99.3.1071
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发表时间：
2002-02-01
期刊：
影响因子：
20.3
通讯作者：
Mackinnon, S
中科院分区：
文献类型：
--
作者：
Chakraverty, R;Peggs, K;Mackinnon, S
在47例接受来自匹配的无关供体的异基因祖细胞的恶性血液病患者中研究了非清髓性预处理方案。患者年龄中位数为44岁。大多数患者具有高风险特征，包括既往移植失败（29人）。20例移植物的FILA I类和/或II类等位基因不匹配。预处理包括第-8至-4天20 mg CAMPATH-1H、第-7至-3天30 mg/m2氟达拉滨和第-2天140 mg/m2美法仑。移植物抗宿主病（GVHD）的预防与环孢素A单独。44例可评价患者中仅2例（4.5%）发生原发性移植物失效。34例患者的嵌合体研究表明，大多数（85.3%）达到初始完全供体嵌合体。仅3例患者发生III至IV级急性GVHD，尚未有患者发生慢性广泛GVHD。第100天非复发死亡率的估计概率为14.9%（95%置信区间[CI]，4.7%-25.1%）。中位随访时间为344天（范围：79-830天），1年时的总体生存率和无进展生存率分别为75.5%（95% CI，62.8%-88.2%）和61.5%（95% CI，46.1%-76.8%）。总之，结合体内CAMPATH-1H的非清髓性方案可有效促进大多数患者的持久植入，并降低匹配的无关供体移植后严重GVHD的风险。(C)2002年，美国血液学会。
A nonmyeloablative conditioning regimen was investigated in 47 patients with hematological malignancy receiving allogeneic progenitor cells from matched, unrelated donors. The median patient age was 44 years. The majority of patients had high-risk features, including having failed a prior transplantation (29 individuals). Twenty of the transplants were mismatched for FILA class I and/or class II alleles. Recipient conditioning consisted of 20 mg CAMPATH-1H on days -8 to -4, 30 mg/m(2) fludarabine on days -7 to -3, and 140 mg/m(2) melphalan on day -2. Graft-versus-host disease (GVHD) prophylaxis was with cyclosporine A alone. Primary graft failure occurred in only 2 of 44 evaluable patients (4.5%). Chimerism studies in 34 patients indicated that the majority (85.3%) attained initial full donor chimerism. Only 3 patients developed grade III to IV acute GVHD, and no patients have yet developed chronic extensive GVHD. The estimated probability of nonrelapse mortality at day 100 was 14.9% (95% confidence interval [CI], 4.7%-25.1%). With a median follow-up of 344 days (range, 79-830), overall and progression-free survivals at 1 year were 75.5% (95% CI, 62.8%-88.2%) and 61.5% (95% CI, 46.1%-76.8%), respectively. In summary, a nonmyeloablative regimen incorporating in vivo CAMPATH-1H is effective in promoting durable engraftment in most patients and in reducing the risk of severe GVHD following matched unrelated donor transplantation. (C) 2002 by The American Society of Hematology.