Impact of ATG-containing reduced-intensity conditioning after single- or double-unit allogeneic cord blood transplantation
Impact of ATG-containing reduced-intensity conditioning after single- or double-unit allogeneic cord blood transplantation
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DOI：
10.1182/blood-2014-09-599241
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发表时间：
2015-08-20
期刊：
影响因子：
20.3
通讯作者：
Yakoub-Agha, Ibrahim
中科院分区：
文献类型：
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作者：
Pascal, Laurent;Tucunduva, Luciana;Yakoub-Agha, Ibrahim
我们分析了661例成人患者，他们接受了单单位（n = 226）或双单位（n = 435）非相关脐带血移植（UCBT），接受了低强度预处理（RIC），包括低剂量全身照射（TBI），环磷酰胺和氟达拉滨（Cy/Flu/TBI 200）。82例患者接受兔抗胸腺细胞球蛋白（ATG）作为预处理方案的一部分（ATG组），而579例患者没有接受（非ATG组）。UCBT的中位年龄为54岁，诊断为急性白血病（51%）、骨髓增生异常综合征/骨髓增生性肿瘤（19%）和淋巴组织增生性疾病（30%）。44%的患者移植时患有晚期疾病。所有患者均接受>= 4种抗原HLA匹配的UCBT。收集的总有核细胞的中位数为4.4 × 10（7）/kg。在ATG组中，64名可评估患者在移植物输注前1天（n = 27）、2天（n = 20）或> 2天（n = 17）停止ATG。在多变量分析中，ATG的使用与急性移植物抗宿主病的发生率降低相关（风险比[HR]，0.31; 95%置信区间[ CI]，0.17-0.55; P < .0001），非复发死亡率较高（HR，1.68; 95% CI，1.16-2.43; P = .0009），总生存期降低（HR，1.69; 95% CI，1.19-2.415; P = .003）。总的来说，我们的研究结果表明，使用ATG可能是有害的，特别是如果在Cy/Flu/TBI 200方案后接受UCBT的成人中过于接近移植物输注。
We analyzed 661 adult patients who underwent single-unit (n = 226) or double-unit (n = 435) unrelated cord blood transplantation (UCBT) following a reduced-intensity conditioning (RIC) consisting of low-dose total body irradiation (TBI), cyclophosphamide, and fludarabine (Cy/Flu/TBI200). Eighty-two patients received rabbit antithymocyte globulin (ATG) as part of the conditioning regimen(ATGgroup), whereas 579 did not (non-ATG group). Median age at UCBT was 54 years, and diagnoses were acute leukemias (51%), myelodysplastic syndrome/myeloproliferative neoplasm (19%), and lymphoproliferative diseases (30%). Forty-four percent of patients were transplanted with advanced disease. All patients received >= 4 antigens HLA-matched UCBT. Median number of collected total nucleated cells was 4.4 3 10(7)/kg. In the ATG group, on 64 evaluable patients, ATG was discontinued 1 (n = 27), 2 (n = 20), or > 2 days before the graft infusion (n = 17). In multivariate analyses, the use of ATG was associated with decreased incidence of acute graft-versus-host disease (hazard ratio [HR], 0.31; 95% confidence interval [ CI], 0.17-0.55; P < .0001), higher incidence of nonrelapse mortality (HR, 1.68; 95% CI, 1.16-2.43; P = .0009), and decreased overall survival (HR, 1.69; 95% CI, 1.19-2.415; P = .003). Collectively, our results suggest that the use of ATG could be detrimental, especially if given too close to graft infusion in adults undergoing UCBT following Cy/Flu/TBI200 regimen.