T-cell depletion of HLA-identical transplants in leukemia.-猫眼课题宝

DOI：

10.1182/blood.v78.8.2120.2120

发表时间：

1991-10

期刊：

Blood

影响因子：

20.3

通讯作者：

中科院分区：

医学1区

文献类型：

作者：

A. M. Marmont;M. Horowitz;R. Gale;K. Sobocinski;Robert;-C.;Ash;Dirk W. van Bekkum;Richard;-E.;Champlin;K. A. Dicke;J. Goldman;Robert A. Good;R. Herzig;Richard Hong;Tohru Masaoka;A. Rimm;Olle Ringdh;Bruno Wilhelm Speck;Roy;Weiner;M. Bortin

我们通过比较731例T细胞耗竭移植和2,480例非T细胞耗竭移植，分析了T细胞耗竭对HLA相合同胞骨髓移植治疗白血病的结果的影响。T细胞耗竭降低急性移植物抗宿主病（GVHD）（相对危险度[RR] 0.45; P <0.0001）和慢性（GVHD）（RR 0.56; P <0.0001）。然而，它增加了移植失败（RR 9.29; P小于0.0001）。白血病复发率也增加。在首次缓解的急性白血病或慢性期慢性粒细胞白血病中，去除T细胞的移植后白血病复发的可能性是其他患者的2.75倍（P <0.0001）。T细胞耗竭增加了治疗失败的风险（RR 1.35; P <0.0003），并降低了无白血病生存率。我们还研究了与T细胞耗竭移植结果相关的可控变量。独特的发现是，在接受T细胞耗竭移植治疗早期白血病的受者中，辐射剂量大于或等于11戈伊，（RR 0.54; P小于.01），剂量率大于14 cGy/min（RR 0.56; P <0.002），以及单独使用环孢霉素的额外移植后免疫抑制（RR 0.53; P小于0.0006）或环孢霉素联合甲氨蝶呤（RR 0.36; P小于0.01）与较少的治疗失败相关。使用单克隆抗体而不是物理技术进行T细胞去除（RR 2.01; P小于0.03）和分次放疗（RR 1.69; P小于0.05）与治疗失败率增加和无白血病生存率降低相关。这些数据可能有助于设计策略，以改善T细胞耗竭移植的结果。

We analyzed the effects of T-cell depletion on the outcome of HLA-identical sibling bone marrow transplants for leukemia by comparing 731 T-cell-depleted transplants with 2,480 non-T-cell-depleted transplants. T-cell depletion decreased acute graft-versus-host disease (GVHD) (relative risk [RR] 0.45; P less than .0001) and chronic (GVHD) (RR 0.56; P less than .0001). However, it increased graft failure (RR 9.29; P less than .0001). Leukemia relapse also was increased. In first remission acute leukemia or chronic phase chronic myelogenous leukemia, leukemia relapse was 2.75 times more likely after T-cell-depleted transplants (P less than .0001). T-cell depletion increased the risk of treatment failure (RR 1.35; P less than .0003) and decreased leukemia-free survival. We also studied controllable variables associated with outcome of T-cell-depleted transplants. The unique findings were that among recipients of T-cell-depleted transplants for early leukemia, radiation doses greater than or equal to 11 Gy (RR 0.54; P less than .01), dose rates greater than 14 cGy/min (RR 0.56; P less than .002), and additional posttransplant immune suppression with cyclosporine alone (RR 0.53; P less than .0006) or cyclosporine plus methotrexate (RR 0.36; P less than .01) were associated with fewer treatment failures. Use of monoclonal antibodies rather than physical techniques for T-cell depletion (RR 2.01; P less than .03) and fractionated radiation (RR 1.69; P less than .05) were associated with increased treatment failure and lower leukemia-free survival. These data may be useful in designing strategies to improve results of T-cell-depleted transplants.

T-cell depletion of HLA-identical transplants in leukemia.

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