T-Cell-Replete HLA-Haploidentical Hematopoietic Transplantation for Hematologic Malignancies Using Post-Transplantation Cyclophosphamide Results in Outcomes Equivalent to Those of Contemporaneous HLA-Matched Related and Unrelated Donor Transplantation
T-Cell-Replete HLA-Haploidentical Hematopoietic Transplantation for Hematologic Malignancies Using Post-Transplantation Cyclophosphamide Results in Outcomes Equivalent to Those of Contemporaneous HLA-Matched Related and Unrelated Donor Transplantation
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DOI：
10.1200/jco.2012.44.3523
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发表时间：
2013-04-01
影响因子：
45.3
通讯作者：
Solomon, Scott R.
中科院分区：
文献类型：
--
作者：
Bashey, Asad;Zhang, Xu;Solomon, Scott R.
目的：对于需要异基因造血细胞移植（alloHCT）但缺乏常规供体的患者，移植后使用环磷酰胺的单倍体相合供者的T细胞充满移植物可能是一种解决方案。我们比较了结果的allo HCT使用单倍体相合的捐助者与移植使用传统的HLA匹配的同胞供体（MRD）和HLA匹配的无关供体（MUDs）。患者和MethodsOutcomes的271例连续患者进行T细胞充满第一allo HCT的恶性血液病同期在一个单一的中心（53使用单倍体相合的捐助者; 117，MRD; 101，MUDs）进行了比较。总体和无病生存期（DFS）进行调整的影响，显着的患者，疾病，和移植相关的协变量使用分层考克斯model.ResultsPatient特征之间的三个捐助者组相似。对于接受MRD、MUD和半相合移植的患者，24个月累积非复发死亡率分别为13%、16%和7%，复发率分别为34%、34%和33%（P无显著性[NS]）。6个月时3 - 4级急性移植物抗宿主病（GVHD）的累积发生率分别为8%、11%和11%（PNS）;广泛慢性GVHD分别发生在54%、54%和38%的患者中（对于接受单倍体相合供体v MRD或MUD移植的患者，P <0.05）。调整后24个月的生存概率分别为76%，67%和64%和DFS分别为53%，52%和60%，分别，这些都没有显着不同的三个捐助者groups. ConclusionHaploidate移植使用T细胞充满移植物和移植后环磷酰胺实现的结果相当于同期移植使用MRD和MUD。这种移植对于缺乏传统捐赠者的患者来说是一种有效的替代方案。临床肿瘤学杂志31：1310-1316。(C)2013年美国临床肿瘤学会
PurposeT-cell-replete grafts from haploidentical donors using post-transplantation cyclophosphamide may represent a solution for patients who require allogeneic hematopoietic cell transplantation (alloHCT) but lack a conventional donor. We compared outcomes of alloHCT using haploidentical donors with those of transplantation using conventional HLA-matched sibling donors (MRDs) and HLA-matched unrelated donors (MUDs).Patients and MethodsOutcomes of 271 consecutive patients undergoing T-cell-replete first alloHCT for hematologic malignancies performed contemporaneously at a single center (53 using haploidentical donors; 117, MRDs; 101, MUDs) were compared. Overall and disease-free survival (DFS) were adjusted for effects of significant patient-, disease-, and transplantation-related covariates using a stratified Cox model.ResultsPatient characteristics were similar between the three donor groups. For patients undergoing MRD, MUD, and haploidentical transplantation, 24-month cumulative incidences of nonrelapse mortality were 13%, 16%, and 7% and of relapse were 34%, 34%, and 33%, respectively (P not significant [NS]). Cumulative incidences of grades 3 to 4 acute graft-versus-host disease (GVHD) at 6 months were 8%, 11%, and 11%, respectively (PNS); extensive chronic GVHD occurred in 54%, 54%, and 38% of patients, respectively (P < .05 for those undergoing haploidentical donor v MRD or MUD transplantation). Adjusted 24-month probabilities of survival were 76%, 67%, and 64% and of DFS were 53%, 52%, and 60%, respectively; these were not significantly different among the three donor groups.ConclusionHaploidentical transplantation performed using T-cell-replete grafts and post-transplantation cyclophosphamide achieves outcomes equivalent to those of contemporaneous transplantation performed using MRDs and MUDs. Such transplantation represents a valid alternative for patients who lack a conventional donor. J Clin Oncol 31:1310-1316. (C) 2013 by American Society of Clinical Oncology