Long-term follow-up of haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for the treatment of leukemia Nine Years of Experience at a Single Center
Long-term follow-up of haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for the treatment of leukemia Nine Years of Experience at a Single Center
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DOI：
10.1002/cncr.27761
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发表时间：
2013-03-01
期刊：
影响因子：
6.2
通讯作者：
Huang, Xiao-Jun
中科院分区：
文献类型：
--
作者：
Wang, Yu;Liu, Dai-Hong;Huang, Xiao-Jun
背景：许多需要同种异体造血干细胞移植（Allo-HSCT）的患者缺乏人类白细胞抗原（HLA）匹配的供体。最近，从没有体外T细胞耗竭（TCD）的家庭捐助者（TCD）中制定了一种新的策略，用于HLA不匹配/单倍型的移植。方法：在过去的9年中，使用作者制定的方案进行了单倍体移植，该方案结合了粒细胞 - 粘液型刺激性因子质骨髓（G-BM）和外周血干细胞，而无需体外TCD。报道了这种治疗方式的长期结果，并提供了风险因素分析。结果：在这些患者中，有752名（99％）达到了持续的，充分的供体chimerism。 2至4年级急性移植抗宿主病（GVHD）的发生率为43％，总慢性GVHD的2年累积发生率为53％。非卷式死亡率的3年累积发生率为18％。标准风险和高风险组的2年累积发生率分别为15％和26％。在756例患者中，有480例在1154天的随访期（范围：335-3511天）中幸存，3年无白血病生存率为68％和49％，在标准风险和高风险组中， 分别。较低的白血病生存期与高危疾病状况（P = .001），慢性脊髓性白血病类型类型（P = .004），嗜中性粒细胞的植入超过13天有关（P = .012）和发生（p = .012）和发生。 2至4年级急性GVHD（p = .019）。结论：作者9年的经验的结果表明，没有体外TCD的单倍体供体的外周血干细胞结合使用，是通过使用作者开发的方案来移植的可靠的干细胞来源。癌症2013。（c）2012年美国癌症学会。
BACKGROUND: Many patients who require allogeneic hematopoietic stem cell transplantation (allo-HSCT) lack a human leukocyte antigen (HLA)-matched donor. Recently, a new strategy was developed for HLA-mismatched/haploidentical transplantation from family donors without in vitro T cell depletion (TCD). METHODS: Over the past 9 years, 756 patients underwent haploidentical transplantation using a protocol developed by the authors, which combines granulocyte-colony stimulating factorprimed bone marrow (G-BM) and peripheral blood stem cells without in vitro TCD. The long-term outcome with this treatment modality was reported, and a risk-factor analysis was provided. RESULTS: Of these patients, 752 (99%) achieved sustained, full donor chimerism. The incidence of grades 2 through 4 acute graft-versus-host disease (GVHD) was 43%, and the 2-year cumulative incidence of total chronic GVHD was 53%. The 3-year cumulative incidence of nonrelapse mortality was 18%. The 2-year cumulative incidences of relapse were 15% and 26% in the standard-risk and high-risk groups, respectively. Of the 756 patients, 480 survived throughout the follow-up period of 1154 days (range: 335-3511 days) with the 3-year leukemia-free survival rates of 68% and 49% in the standard-risk and high-risk groups, respectively. Lower leukemia-free survival was associated with high-risk disease status (P = .001), chronic myelogenous leukemia disease type (P = .004), neutrophil engraftment beyond 13 days after transplant (P = .012), and the occurrence of grades 2 through 4 acute GVHD (P = .019). CONCLUSIONS: The results from the authors' 9-year experience showed that G-BM combined with peripheral blood stem cells from haploidentical donors, without in vitro TCD, is a reliable source of stem cells for transplantation by using the protocol developed by the authors. Cancer 2013. (c) 2012 American Cancer Society.