Improved outcome with T-cell-depleted bone marrow transplantation for acute leukemia
Improved outcome with T-cell-depleted bone marrow transplantation for acute leukemia
复制标题
DOI：
10.1200/jco.1999.17.5.1545
复制
发表时间：
1999-05-01
影响因子：
45.3
通讯作者：
Martelli, MF
中科院分区：
文献类型：
--
作者：
Aversa, F;Terenzi, A;Martelli, MF
目的：为了消除排斥反应的风险和降低复发的风险后，T细胞耗尽的骨髓移植急性白血病患者，我们加强移植前免疫抑制和myeloablation.Patients和方法：抗胸腺细胞球蛋白和塞替派被添加到标准全身照射/环磷酰胺调理。供体骨髓通过大豆凝集和E-玫瑰花结法体外去除T淋巴细胞。这种方法进行了测试，在54例连续急性白血病患者接受移植HLA相同的同胞供体，或在两种情况下，从家庭捐助者不匹配的D-DR. No移植后免疫抑制治疗wets作为移植物抗宿主病（GVHD）prophylaxy.Results：既没有移植物排斥反应，也没有GVHD发生。在移植时，36例缓解患者中有6例（16.6%）发生移植相关死亡，18例复发患者中有7例（38.8%）发生移植相关死亡。急性髓性白血病患者的复发概率为0.12（95%置信区间[CI]，0至0.19），急性淋巴细胞白血病患者在第一次或第二次缓解时接受移植的复发概率为0.28（95% CI，0.05至0.51）。中位随访时间为6.9年（最短随访时间为4.9年），缓解期接受移植的患者的无事件生存率为0.74（95%CI，0.54至0.93），急性髓细胞白血病患者为0.59（95%CI，0.35至0.82）。所有存活的患者有100%的性能status.Conclusion：添加抗胸腺细胞球蛋白和噻替派的预处理方案，防止排斥反应的广泛T细胞耗竭的骨髓。即使在完全没有GVHD的情况下，白血病复发率也不高于未经操作的移植。J Clin Oncol 17：1545-1550. (C)1999年，美国临床肿瘤学会。
Purpose: To eliminate the risk of rejection and lower the risk of relapse after T-cell-depleted bone marrow transplants in acute leukemia patients, we enhanced pretransplant immunosuppression and myeloablation.Patients and Methods: Antithymocyte globulin and thiotepa were added to standard total-body irradiation/ cyclophosphamide conditioning. Donor bone marrows were depleted ex vivo of T lymphocytes by soybean agglutination and E-rosetting. This approach was tested in 54 consecutive patients with acute leukemia who received transplants from HLA-identical sibling donors or, in two cases, from family donors mismatched at D-DR. No posttransplant immunosuppressive treatment wets given as graft-versus-host disease (GVHD) prophylaxis.Results: Neither graft rejection nor GVHD occurred. Transplant-related deaths occurred in six(16.6%) of 36 patients in remission and in seven (38.8%) of 18 patients in relapse at the time of transplantation. The probability of relapse was .12 (95% confidence interval [CI], 0 to .19)far patients with acute myeloid leukemia and .28 (95% Cl, .05 to .51) for patients with acute lymphoblastic leukemia who received transplants at the first or second remission. At a median follow-up of 6.9 years (minimum follow-up, 4.9 years), event-free survival for patients who received transplants while in remission was .74 (95% Cl, .54 to .93) for acute myeloid leukemia patients and .59 (95% Cl, .35 to .82) for acute lymphoblastic leukemia patients. All surviving patients have 100% performance status.Conclusion: Adding antithymocyte globulin and thiotepa to the conditioning regimen prevents rejection of extensively T-cell-depleted bone marrow. Even in the complete absence of GVHD, the leukemia relapse rate is not higher than in unmanipulated transplants. J Clin Oncol 17:1545-1550. (C) 1999 by American Society of Clinical Oncology.