Factors Associated with Long-Term Risk of Relapse after Unrelated Cord Blood Transplantation in Children with Acute Lymphoblastic Leukemia in Remission.
Factors Associated with Long-Term Risk of Relapse after Unrelated Cord Blood Transplantation in Children with Acute Lymphoblastic Leukemia in Remission.
复制标题
缓解急性淋巴细胞白血病儿童无关绳索血液移植后长期复发风险相关的因素。
DOI：
10.1016/j.bbmt.2017.04.015
复制
发表时间：
2017-08
期刊：
影响因子：
--
通讯作者：
Rocha V
中科院分区：
文献类型：
--
作者：
Page KM;Labopin M;Ruggeri A;Michel G;Diaz de Heredia C;O'Brien T;Picardi A;Ayas M;Bittencourt H;Vora AJ;Troy J;Bonfim C;Volt F;Gluckman E;Bader P;Kurtzberg J;Rocha V
对于儿童急性淋巴细胞白血病(ALL)患者，复发是非亲缘脐血移植(UCBT)后治疗失败的重要原因。与其他供者来源相比，UCBT后的复发相似，甚至减少，尽管移植物抗宿主病(GvHD)较少。我们进行了一项回顾性分析，以确定与UCBT后5年累计复发率(CI)相关的危险因素。在这项基于注册的回顾性研究中，我们研究了从2000-2012年间接受清髓性调理后接受单一单元脐带血移植的640名(18岁)急性淋巴细胞白血病(ALL)首次缓解(257例，40%)或第二次完全缓解(CR；383例，60%)儿童的结局。大多数接受抗胸腺细胞球蛋白(88%)或全身照射(TBI；69%)的患者和脐带血移植物在1(50%)或2+(34%)基因座上主要不匹配。考虑CR1患者，5年OS、无白血病生存率(LFS)和复发率分别为59%、52%和23%。在多变量分析(MVA)中，急性移植物抗宿主病(II-IV级)和脑外伤预防复发。在CR2患者中，5年OS、LFS和复发CI分别为46%、44%和28%。在多发性骨髓瘤中，从诊断到脐带血移植的时间较长(≥为30个月)和脑外伤与降低复发风险相关。重要的是，接受完全相合的移植是增加MVA复发的一个强烈的危险因素。一项对所有640名患者的探索性分析支持了急性移植物抗宿主病的存在和较少复发之间的重要关联，但也证明了NRM的风险增加。综上所述，移植物抗宿主病作为移植物抗宿主病标志物对儿童脐带血移植后的影响是显而易见的。应进一步研究在利用GvHD的同时促进GVL的战略。
For pediatric patients with acute lymphoblastic leukemia (ALL), relapse is an important cause of treatment failure after unrelated cord blood transplant (UCBT). Compared to other donor sources, relapse is similar or even reduced after UCBT despite less graft-versus-host disease (GvHD). We performed a retrospective analysis to identify risk factors associated with the 5-year cumulative incidence (CI) of relapse after UCBT. In this retrospective, registry-based study, we examined the outcomes of 640 children (<18 years) with ALL in first (n = 257, 40%) or second complete remission (CR; n = 383, 60%) who received myeloablative conditioning followed by a single-unit UCBT from 2000–2012. Most received anti-thymocyte globulin (88%) or total body irradiation (TBI; 69%) and cord blood grafts were primarily mismatched at 1 (50%) or 2+ (34%) HLA loci. Considering CR1 patients, the 5-year OS, leukemia-free survival (LFS), and relapse were 59%, 52%, and 23%, respectively. In multivariate analysis (MVA), acute GvHD (grade II–IV) and TBI protected against relapse. In CR2 patients, 5-year OS, LFS and the CI of relapse were 46%, 44%, and 28%, respectively. In MVA, longer duration from diagnosis to UCBT (≥30 months) and TBI were associated with decreased relapse risk. Importantly, receiving a fully HLA matched graft was a strong risk factor for increased relapse in MVA. An exploratory analysis of all 640 patients supported the important association between the presence of acute GvHD and less relapse, but also demonstrated an increased risk of NRM. In conclusion, the impact of GvHD as a GvL marker is evident in pediatric ALL after UCBT. Strategies that promote GvL while harnessing GvHD should be further investigated.
登录
查看更多内容
DOI：
10.1016/j.bbmt.2015.08.023
发表时间：
2015-12
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Burke MJ;Verneris MR;Le Rademacher J;He W;Abdel-Azim H;Abraham AA;Auletta JJ;Ayas M;Brown VI;Cairo MS;Chan KW;Diaz Perez MA;Dvorak CC;Egeler RM;Eldjerou L;Frangoul H;Guilcher GMT;Hayashi RJ;Ibrahim A;Kasow KA;Leung WH;Olsson RF;Pulsipher MA;Shah N;Shah NN;Thiel E;Talano JA;Kitko CL
通讯作者：
Kitko CL
影响因子：
4.8
作者：
Chen YB;Wang T;Hemmer MT;Brady C;Couriel DR;Alousi A;Pidala J;Urbano-Ispizua A;Choi SW;Nishihori T;Teshima T;Inamoto Y;Wirk B;Marks DI;Abdel-Azim H;Lehmann L;Yu L;Bitan M;Cairo MS;Qayed M;Salit R;Gale RP;Martino R;Jaglowski S;Bajel A;Savani B;Frangoul H;Lewis ID;Storek J;Askar M;Kharfan-Dabaja MA;Aljurf M;Ringden O;Reshef R;Olsson RF;Hashmi S;Seo S;Spitzer TR;MacMillan ML;Lazaryan A;Spellman SR;Arora M;Cutler CS
通讯作者：
Cutler CS
影响因子：
20.3
作者：
Eapen, M;Raetz, E;Davies, SM
通讯作者：
Davies, SM
影响因子：
45.3
作者：
Bader, P;Kreyenberg, H;Klingebiel, T
通讯作者：
Klingebiel, T
影响因子：
4.8
作者：
Bunin, N;Aplenc, R;Simms, S
通讯作者：
Simms, S