Effect of Granulocyte Colony-Stimulating Factor-Combined Conditioning in Cord Blood Transplantation for Myelodysplastic Syndrome and Secondary Acute Myeloid Leukemia: A Retrospective Study in Japan
Effect of Granulocyte Colony-Stimulating Factor-Combined Conditioning in Cord Blood Transplantation for Myelodysplastic Syndrome and Secondary Acute Myeloid Leukemia: A Retrospective Study in Japan
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DOI：
10.1016/j.bbmt.2015.05.009
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发表时间：
2015-09-01
影响因子：
4.3
通讯作者：
Miyazaki, Yasushi
中科院分区：
文献类型：
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作者：
Konuma, Takaaki;Takahashi, Satoshi;Miyazaki, Yasushi
粒细胞集落刺激因子(G-CSF)通过诱导细胞周期进入，增加处于休眠状态的恶性或非恶性造血细胞对阿糖胞苷(Ara-C)的敏感性。因此，在异基因干细胞移植前联合应用G-CSF可能有助于减少复发和移植物失败的发生率，而不必增加细胞毒药物的剂量。我们对336例成人骨髓增生异常综合征(MDS)和继发性急性髓系白血病(SAML)患者进行了4种不同的预适应方案：全身照射(TBI)+GT；=8GY+Ara-C/G-CSF+环磷酰胺(CY)(n=65)，TBI+GT=8GY+Ara-C+CY(n=119)，TBI+GT=8Gy+Other(n=104)，或TBI+Lt；8GY(n=48)。与未使用G-CSF方案的患者相比，接受8GY+Ara-C/G-CSF+CY方案的患者中性粒细胞植入率显著升高(风险比1.52；95%可信区间1.10至2.08；P=0.009)，总死亡率较低(风险比0.46；95%可信区间0.26至0.82；P=0.008)。这项回顾性研究表明，G-CSF联合预适应方案具有更好的植入率和存活率。对患有MDS和SAML的成年人进行CBT。(C)2015年美国血液和骨髓移植学会。
Granulocyte colony stimulating factor (G-CSF) increases the susceptibility of dormant malignant or nonmalignant hematopoietic cells to cytarabine arabinoside (Ara-C) through the induction of cell cycle entry. Therefore, G-CSF combined conditioning before allogeneic stem cell transplantation might positively contribute to decreased incidences of relapse and graft failure without having to increase the dose of cytotoxic drugs. We conducted a retrospective nationwide study of 336 adult patients with myelodysplastic syndrome (MDS) and secondary acute myeloid leukemia (sAML) after single-unit cord blood transplantation (CBT) who underwent 4 different kinds of conditioning regimens: total body irradiation (TBI) >= 8 Gy + Ara-C/G-CSF + cyclophosphamide (CY) (n = 65), TBI >= 8 Gy + Ara-C + CY (n = 119), TBI >= 8 Gy +other (n = 104), or TBI < 8 Gy or non-TBI (n = 48). The TBI >= 8 Gy + Ara-C/G-CSF + CY regimen showed significantly higher incidence of neutrophil engraftment (hazard ratio, 1.52; 95% confidence interval [CI], 1.10 to 2.08; P = .009) and lower overall mortality (hazard ratio, .46; 95% CI, .26 to .82; P = .008) rates compared with those without a G-CSF regimen. This retrospective study shows that the G-CSF combined conditioning regimen provides better engraftment and survival results. in CBT for adults with MDS and sAML. (C) 2015 American Society for Blood and Marrow Transplantation.