Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies
Impact of rabbit ATG-containing myeloablative conditioning regimens on the outcome of patients undergoing unrelated single-unit cord blood transplantation for hematological malignancies
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DOI：
10.1038/bmt.2014.216
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发表时间：
2015-01-01
影响因子：
4.8
通讯作者：
Yakoub-Agha, I.
中科院分区：
文献类型：
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作者：
Pascal, L.;Mohty, M.;Yakoub-Agha, I.
这项研究旨在评估抗胸腺细胞球蛋白(ATG)对91例患者(中位年龄：12岁)的影响，这些患者接受了清髓调节方案后的非亲缘单单位脐血移植(allo-CBT)。脐带血HLA6个相合(6/6，n=18；21%)，1个抗原不相合(30个，35%)，2个抗原不相合(38个，44%)。OS、无复发死亡率和累积复发率分别为47+/-6%、23+/-4%和48+/-5%。在46例接受ATG作为预适应方案一部分的患者中，急、慢性移植物抗宿主病的发生率低于未接受ATG的45例患者(20%比43%；P=0.03)。然而，多因素统计分析显示，使用ATG分别与OS和EFS发生率降低以及NRM的高发生率相关(危险比(HR)=1.99，95%可信区间(CI)：1.11~3.59，P=0.02)、(HR=1.83，95%CI：1.08~3.10，P=0.02)和(HR=2.54，95%CI：1.03~6.26，P=0.04)。因此，我们的结果不支持在年轻的恶性血液病患者进行单单位异基因CBT之前使用ATG作为清髓性预适应方案的一部分。
This study aimed to assess the impact of antithymocyte globulin (ATG) on patient outcome in a retrospective series of 91 patients (median age: 12 years) who underwent unrelated single-unit cord blood transplantation (allo-CBT) following a myeloablative conditioning regimen. Cord blood units were HLA-matched (6/6, n = 18; 21%), one-Ag mismatched (n = 30, 35%) or two-Ag mismatched (n = 38; 44%). In this series, the OS, nonrelapse mortality (NRM) and cumulative incidence of relapse were 47 +/- 6%, 23 +/- 4% and 48 +/- 5%, respectively. Among 46 patients who received ATG as part of the conditioning regimen, the incidence of acute and chronic GVHD was lower than that in the group of 45 patients who did not receive ATG (20% vs 43%; P = 0.03). However, multivariate statistical analysis revealed that the ATG use was associated with decreased OS and EFS rates and a high incidence of NRM (hazard ratio (HR) = 1.99, 95% confidence interval (CI): 1.11-3.59, P = 0.02), (HR = 1.83, 95% CI: 1.08-3.10, P = 0.02) and (HR = 2.54, 95% CI: 1.03-6.26, P = 0.04), respectively. Therefore, our results do not support the use of ATG as part of a myeloablative-conditioning regimen before single-unit allo-CBT in younger patients with hematological malignancies.