GvHD prophylaxis after single-unit reduced intensity conditioning cord blood transplantation in adults with acute leukemia
GvHD prophylaxis after single-unit reduced intensity conditioning cord blood transplantation in adults with acute leukemia
复制标题
成人急性白血病单单位降低强度调理脐带血移植后的 GvHD 预防
DOI：
10.1038/bmt.2017.116
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Teshima T
中科院分区：
文献类型：
--
作者：
Terakura S;Kuwatsuka Y;Yamasaki S;Wake A;Kanda J;Inamoto Y;Mizuta S;Yamaguchi T;Uchida N;Kouzai Y;Aotsuka N;Ogawa H;Kanamori H;Nishiwaki K;Miyakoshi S;Onizuka M;Amano I;Fukuda T;Ichinohe T;Atsuta Y;Murata M;Teshima T
为了研究降低强度调节脐带血移植 (RIC-UCBT) 中更好的 GVHD 预防，我们使用注册数据比较了 UCBT 后 GvHD 预防的移植结果。我们选择了接受钙调神经磷酸酶抑制剂和甲氨蝶呤 (MTX)/吗替麦考酚酯 (MMF) 联合治疗的 AML 或 ALL 移植患者。 2000年至2012年间总共纳入748例首次RIC-UCBT（MTX+组，446例，MMF+组，302例）。 MMF+组中性粒细胞和血小板计数累积发生率高于50 000/μL的情况明显更好（相对风险（RR），1.55；P<0.001：RR，1.34；P=0.003）。在多变量分析中，MMF+组发生II-IV级和III-IV级急性GvHD的风险显着高于MTX+组（RR，1.75；P<0.001：RR，1.97；P=0.004）。在AML的疾病特异性分析中，MMF+组的高危疾病复发风险显着较低（RR，0.69；P=0.009），而高危疾病的无复发风险和总生存率没有显着差异。在患有标准风险疾病的患者中，MTX+ 和 MMF+ 组之间的复发或生存风险没有显着差异。总的来说，这些结果表明，在 RIC-UCBT 中，含 MMF 的预防可能更可取，特别是对于高危疾病。
To investigate better GVHD prophylaxis in reduced intensity conditioning umbilical cord blood transplantation (RIC-UCBT), we compared transplant outcomes after UCBT among GvHD prophylaxes using the registry data. We selected patients transplanted for AML or ALL with a calcineurin inhibitor and methotrexate (MTX)/mycophenolate mofetil (MMF) combination. A total of 748 first RIC-UCBT between 2000 and 2012 (MTX+ group, 446, MMF+ group, 302) were included. The cumulative incidence of neutrophil and platelet counts higher than 50 000/μL was significantly better in the MMF+ group (relative risk (RR), 1.55; P< 0.001: RR, 1.34; P= 0.003, respectively). In multivariate analyses, the risk of grade II–IV and III–IV acute GvHD was significantly higher in the MMF+ group than in the MTX+ group (RR, 1.75; P< 0.001: RR, 1.97; P= 0.004, respectively). In disease-specific analyses of AML, the risk of relapse of high-risk disease was significantly lower in the MMF+ group (RR, 0.69; P= 0.009), whereas no significant difference was observed in the risk of relapse-free and overall survival in high-risk disease. In patients with standard-risk disease, no significant differences were noted in the risk of relapse or survival between the MTX+ and MMF+ groups. Collectively, these results suggest that MMF-containing prophylaxis may be preferable in RIC-UCBT, particularly for high-risk disease.