Double umbilical cord blood transplantation with reduced intensity conditioning and sirolimus-based GVHD prophylaxis.
Double umbilical cord blood transplantation with reduced intensity conditioning and sirolimus-based GVHD prophylaxis.
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DOI：
10.1038/bmt.2010.192
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发表时间：
2011-05
影响因子：
4.8
通讯作者：
Ballen K
中科院分区：
文献类型：
--
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
成人脐带血移植(UCBT)的主要局限性是植入延迟、免疫重建差和高无复发死亡率(NRM)。双重脐带血移植(Double UCBT，DUCBT)已被用于避免低细胞剂量的问题，但急性移植物抗宿主病(GVHD)仍然是一个重要的问题。我们描述了32名受试者的经验，这些受试者在使用氟达拉滨/马法兰/抗胸腺细胞球蛋白进行低强度预适应后接受了DUCBT，并接受了西罗莫司和他克莫司预防急性GVHD。所有患者中性粒细胞植入的中位数为21天，血小板植入的中位数为42天。急性移植物抗宿主病3例(9.4%)，慢性移植物抗宿主病4例(累积发生率12.5%)。100天无GVHD死亡，NRM为12.5%。2年NRM、无进展生存率(PFS)和总生存率(OS)分别为34.4%、31.2%和53.1%。正如预期的那样，免疫重建是缓慢的，但PFS和OS与CD4+和CD8+淋巴细胞亚群的重建有关，提示适应性免疫的恢复是预防移植后感染和复发所必需的。综上所述，西罗莫司和他克莫司在DUCBT中提供了良好的GVHD预防，该方案与DUCBT后低NRM相关。
The main limitations to umbilical cord blood transplantation (UCBT) in adults are delayed engraftment, poor immunological reconstitution and high rates of non-relapse mortality (NRM). Double UCBT (DUCBT) has been used to circumvent the issue of low cell dose, but acute graft-vs.-host disease (GVHD) remains a significant problem. We describe our experience in 32 subjects who underwent DUCBT after reduced-intensity conditioning with fludarabine/melphalan/anti-thymocyte globulin and who received sirolimus and tacrolimus to prevent acute GVHD. Engraftment of neutrophils occurred in all patients at a median of 21 days, and platelet engraftment occurred at a median of 42 days. Three subjects had grade II-IV acute GVHD (9.4%) and chronic GVHD occurred in 4 subjects (cumulative incidence 12.5%). No deaths were caused by GVHD and NRM at 100 days was 12.5%. At two years, NRM, progression-free survival (PFS) and overall survival (OS) were 34.4%, 31.2% and 53.1%, respectively. As expected, immunologic reconstitution was slow, but PFS and OS were associated with reconstitution of CD4+ and CD8+ lymphocyte subsets, suggesting that recovery of adaptive immunity is required for prevention of infection and relapse after transplantation. In summary, sirolimus and tacrolimus provide excellent GVHD prophylaxis in DUCBT, and this regimen is associated with low NRM after DUCBT.
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影响因子：
45.3
作者：
Rodrigues, Celso A.;Sanz, Guillermo;Rocha, Vanderson
通讯作者：
Rocha, Vanderson
DOI：
10.1073/pnas.92.22.10119
发表时间：
1995-10-24
影响因子：
11.1
作者：
RUBINSTEIN, P;DOBRILA, L;STEVENS, CE
通讯作者：
STEVENS, CE
影响因子：
158.5
作者：
Laughlin, MJ;Eapen, M;Horowitz, MM
通讯作者：
Horowitz, MM
影响因子：
4.3
作者：
Brunstein, Claudio G.;Cantero, Susano;Wagner, John E.
通讯作者：
Wagner, John E.
影响因子：
2.1
作者：
Mathew, T;Kreis, H;Friend, P
通讯作者：
Friend, P