BEAM-alemtuzumab reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases: GVHD, toxicity, and survival in 65 patients
BEAM-alemtuzumab reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases: GVHD, toxicity, and survival in 65 patients
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DOI：
10.1182/blood-2003-05-1406
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发表时间：
2004-01-15
期刊：
影响因子：
20.3
通讯作者：
Russell, NH
中科院分区：
文献类型：
--
作者：
Faulkner, RD;Craddock, C;Russell, NH
我们报告了英国6家移植中心使用BEAM-阿仑单抗预处理（卡莫司汀、依托泊苷、阿糖胞苷、美法仑和阿仑单抗10 mg/d，第-5天至第-1天）进行低强度异基因干细胞移植的结局。65例淋巴组织增生性疾病患者接受了同胞（n=57）或匹配的无关供体（n=8）移植。62例患者中有60例（97%）发生持续供体植入。在接受嵌合体研究的56例患者中，35例（63%）具有完全供体嵌合体。总体而言，73%的患者在移植后完全缓解（CR）。中位随访时间为1.4年（范围：0.1-5.6年），37例患者仍存活并达到CR。64例患者中有11例（117%）发生急性移植物抗宿主病（GVHD），仅为I-II级。首次移植患者的1年移植相关死亡率（TRM）估计为8%，但既往接受过自体移植的患者明显更差。6例患者复发（估计2年复发风险为20%）。组织学诊断（套细胞淋巴瘤和高级别非霍奇金淋巴瘤）和移植时年龄（>46岁）与较高的复发风险和较差的无事件生存率显著相关。在任何发生急性或慢性GVHD的患者中均未发生复发。这项研究表明，使用BEAM-Alemtuzumab制备方案进行的低强度异基因干细胞移植治疗淋巴增生性疾病与持续供体植入、高应答率、最小毒性和低GVHD发生率相关。
We report the outcomes of reduced-intensity allogeneic stem cell transplantation using BEAM-alemtuzumab conditioning (carmustine, etoposide, cytosine arabinoside, melphalan, and alemtuzumab 10 mg/d on days -5 to -1) in 6 United Kingdom transplant centers. Sixty-five patients with lymphoproliferative diseases underwent sibling (n=57) or matched unrelated donor (n=8) transplantation. Sustained donor engraftment occurred in 60 (97%) of 62 patients. Of the 56 patients undergoing chimerism studies, 35 (63%) had full donor chimerism. Overall, 73% were in complete remission (CR) after transplantation. At a median follow-up of 1.4 years (range, 0.1-5.6 years), 37 remain alive and in CR. Acute graft-versus-host disease (GVHD) occurred in 11 (117%) of 64, grades I-II only. Estimated 1-year transplantation-related mortality (TRM) was 8% for patients undergoing first transplantation but was significantly worse for those who had previously undergone autologous transplantation. Six patients relapsed (estimated 2-year relapse risk, 20%). Histologic diagnosis (mantle cell lymphoma and high-grade non-Hodgkin lymphoma) and age at transplantation (>46 years) were significantly associated with higher relapse risk and worse event-free survival. Relapse did not occur in any patient who developed acute or chronic GVHD. This study demonstrates that reduced-intensity allogeneic stem cell transplantation for lymphoproliferative diseases using a BEAM-alemtuzumab preparative regimen is associated with sustained donor engraftment, a high response rate, minimal toxicity, and a low incidence of GVHD.