Excellent outcome of allogeneic hematopoietic stem cell transplantation using a conditioning regimen with medium-dose VP-16, cyclophosphamide and total-body irradiation for adult patients with acute lymphoblastic leukemia
Excellent outcome of allogeneic hematopoietic stem cell transplantation using a conditioning regimen with medium-dose VP-16, cyclophosphamide and total-body irradiation for adult patients with acute lymphoblastic leukemia
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DOI：
10.1016/j.bbmt.2008.02.018
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发表时间：
2008-05-01
影响因子：
4.3
通讯作者：
Imamura, Masahiro
中科院分区：
文献类型：
--
作者：
Shigematsu, Akio;Kondo, Takeshi;Imamura, Masahiro
我们回顾性评估了37例接受同种异体造血干细胞移植（alloc - sct）的急性淋巴细胞白血病（AML）成年患者的结果，这些患者接受中剂量VP-16 （VP, 30 mg/kg）、环磷酰胺（CY, 120 mg/kg）和分次全身照射（TBI, 12 Gy）（中剂量VP/CY/TBI）。患者的中位年龄为26岁。13例患者接受hla匹配相关供体移植（MRD）， 18例患者接受hla匹配非相关供体移植（MUD）， 6例患者接受hla错配供体移植（MMD）。骨髓移植32例，外周血干细胞移植4例。10例患者为费城染色体阳性（Ph+）， 35例患者在移植时完全缓解（CR）。所有患者移植成功，27例患者移植前发生3级器官毒性。H-M级急性移植物抗宿主病（GVHD）和慢性移植物抗宿主病（cGVHD）分别发生15例和18例。没有患者发展为IV级急性GVHD （aGVHD）或死于GVHD。中位随访35.1个月，32例患者存活，所有Ph+患者存活。3例复发死亡，2例移植相关死亡（TRM）。精算3年总生存率（OS）、复发率和TRM率分别为89.2%、8.1%和5.4%。移植时无cr、MRD和无aGVHD是影响生存的重要不良预后因素。成人ALL患者中剂量VP/CY/TBI复发率较低，毒性未增加，生存期较好。(C) 2008年美国血液和骨髓移植学会。
We retrospectively evaluated the outcomes of 37 adult patients with acute lymphoblastic leukemia (AML) undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT) conditioned with medium-dose VP-16 (VP, 30 mg/kg), cyclophosphamide, (CY, 120 mg/kg), and fractionated total-body irradiation (TBI, 12 Gy) (medium-dose VP/CY/TBI). The median age of the patients was 26 years. Thirteen patients underwent transplantation from HLA-matched related donors (MRD), 18 patients underwent transplantation from HLA-matched unrelated donors (MUD), and 6 patients underwent transplantation from HLA-mismatched donors (MMD). Thirty-two patients received bone marrow and 4 patients received peripheral blood stem cells. Ten patients were Philadelphia chromosome-positive (Ph+) and 35 patients were in complete remission (CR) at transplantation. All of the patients achieved engraftment, and grade 3 organ toxicity before engraftment occurred in 27 patients. Grade H-M acute graft-versus-host disease (GVHD) and chronic GVHD (cGVHD) occurred in 15 and 18 patients, respectively. No patient developed grade IV acute GVHD (aGVHD) or died of GVHD. At median follow-up of 35.1 months, 32 patients were alive and all Ph+ patients were alive. Three patients died of relapse and 2 died of transplant-related mortality (TRM). The actuarial 3-year overall survival (OS) rate, relapse rate, and TRM rate were 89.2%, 8.1%, and 5.4%, respectively. Non-CR at transplantation, MRD, and no aGVHD were significant adverse prognostic factors for survival. Medium-dose VP/CY/TBI for adult ALL patients was associated with lower relapse rate and no increase in toxicity, resulting in better survival. (C) 2008 American Society for Blood and Marrow Transplantation.