A novel reduced-intensity conditioning regimen induces a high incidence of sustained donor-derived neutrophil and platelet engraftment after double-unit cord blood transplantation.
A novel reduced-intensity conditioning regimen induces a high incidence of sustained donor-derived neutrophil and platelet engraftment after double-unit cord blood transplantation.
复制标题
DOI：
10.1016/j.bbmt.2013.02.007
复制
发表时间：
2013-05
影响因子：
4.3
通讯作者：
Barker, Juliet N.
中科院分区：
文献类型：
--
作者：
Ponce, Doris M.;Sauter, Craig;Devlin, Sean;Lubin, Marissa;Gonzales, Anne Marie;Kernan, Nancy A.;Scaradavou, Andromachi;Giralt, Sergio;Goldberg, Jenna D.;Koehne, Guenther;Perales, Miguel A.;Young, James W.;Castro-Malaspina, Hugo;Jakubowski, Ann;Papadopoulos, Esperanza B.;Barker, Juliet N.
需要一种低强度的准备方案，可以可靠地植入脐带血，并用作大剂量清髓或非清髓条件的替代。采用环磷酰胺50 mg/kg、氟达拉滨150 mg/m2、硫替巴10 mg/kg、环孢素A/霉酚酸酯免疫抑制400cGy全身照射方案，对30例急性白血病或骨髓发育不良患者进行双单位脐血移植(CBT)。97%的患者移植的平均时间为26天(范围13-43天)，93%的患者在180天前恢复了血小板。180d时II-IV级急性移植物抗宿主病(GVHD)发生率为67%，1年时慢性GVHD发生率为10%。移植相关死亡率(TRM)在180d时为20%，2年时复发率为11%。总体而言，两年无病生存率(DFS)为60%。根据Sorror共病评分，DFS有一个等级：评分为1的11名患者(中位年龄55岁)的2年DFS为82%，而评分为2-3的9名患者(中位年龄51岁)的2年DFS为62%，而评分为4-5的11名患者(中位年龄58岁)的2年DFS为40%(p=0.13)。这种低强度方案与双单位CBT相结合，可靠地促进了没有抗胸腺细胞球蛋白的持续供体植入。虽然高共病分数的患者需要其他方法，但这种方案对≥50年的患者非常有效，否则他们的身体状况还可以接受。它也是年轻患者大剂量调理的一种有希望的替代方案。
A preparative regimen of reduced intensity that can reliably engraft cord blood (CB) and be used as an alternative to either high-dose myeloablative or non-myeloablative conditioning is needed. We evaluated double-unit CB transplantation (CBT) in 30 patients (median age 56 years range 18–69) with acute leukemia or myelodysplasia using a regimen of cyclophosphamide 50 mg/kg, fludarabine 150 mg/m2, thiotepa 10 mg/kg, and 400 cGy total body irradiation with cyclosporine-A/mycophenolate mofetil immunosuppression. Ninety-seven percent of patients engrafted at a median of 26 days (range 13–43), and 93% of patients had recovered platelets by day 180. Grade II–IV acute graft-versus-host disease (GVHD) incidence was 67% at day 180, and chronic GVHD was 10% at 1-year. Transplant-related mortality (TRM) was 20% at day 180, and relapse was 11% at 2-years. Overall, 2-year disease-free survival (DFS) is 60% at 2-years. There was a hierarchy in DFS according to the Sorror comorbidity score: the 11 patients (median age 55 years) with a score of 1 had a 2-year DFS of 82% compared with 62% in the 9 patients (median age 51 years) with a score of 2–3, and 40% in the 11 patients (median age 58 years) with a score of 4–5 (p = 0.13). This reduced intensity regimen combined with double-unit CBT reliably facilitates sustained donor engraftment without anti-thymocyte globulin. While other approaches are needed in patients with high comorbidity scores, this regimen is highly effective in patients ≥ 50 years who are otherwise reasonably fit. It also represents a promising alternative to high-dose conditioning in younger patients.
登录
查看更多内容
影响因子：
4.8
作者：
Kindwall-Keller TL;Hegerfeldt Y;Meyerson HJ;Margevicius S;Fu P;van Heeckeren W;Lazarus HM;Cooper BW;Gerson SL;Barr P;Tse WW;Curtis C;Fanning LR;Creger RJ;Carlson-Barko JM;Laughlin MJ
通讯作者：
Laughlin MJ
影响因子：
45.3
作者：
Rodrigues, Celso A.;Sanz, Guillermo;Rocha, Vanderson
通讯作者：
Rocha, Vanderson
DOI：
10.1016/j.bbmt.2008.06.009
发表时间：
2008-09
期刊：
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
影响因子：
--
作者：
Bredeson CN;Zhang MJ;Agovi MA;Bacigalupo A;Bahlis NJ;Ballen K;Brown C;Chaudhry MA;Horowitz MM;Kurian S;Quinlan D;Muehlenbien CE;Russell JA;Savoie L;Rizzo JD;Stewart DA
通讯作者：
Stewart DA
影响因子：
4.3
作者：
Bacigalupo, Andrea;Ballen, Karen;Rizzo, Doug;Giralt, Sergio;Lazarus, Hillard;Ho, Vincent;Apperley, Jane;Slavin, Shimon;Pasquini, Marcelo;Sandmaier, Brenda M.;Barrett, John;Blaise, Didier;Lowski, Robert;Horowitz, Mary
通讯作者：
Horowitz, Mary
影响因子：
4.8
作者：
Cutler C;Stevenson K;Kim HT;Brown J;McDonough S;Herrera M;Reynolds C;Liney D;Kao G;Ho V;Armand P;Koreth J;Alyea E;Dey BR;Attar E;Spitzer T;Boussiotis VA;Ritz J;Soiffer R;Antin JH;Ballen K
通讯作者：
Ballen K