PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL
PTCy-based haploidentical vs matched related or unrelated donor reduced-intensity conditioning transplant for DLBCL
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DOI：
10.1182/bloodadvances.2018027748
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发表时间：
2019-02-12
期刊：
影响因子：
7.5
通讯作者：
Hamadani, Mehdi
中科院分区：
文献类型：
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作者：
Dreger, Peter;Sureda, Anna;Hamadani, Mehdi
本研究回顾性比较了复发性弥漫性大b细胞淋巴瘤（DLBCL）患者采用移植后环磷酰胺（PTCy）与匹配的兄弟姐妹供体（MSD）和匹配的非亲属供体（MUD）进行非清髓性/降低强度调节（NMC/RIC）同种异体造血细胞移植（alloo - hct）的长期结果，这些患者有或没有t细胞耗损（TCD+/TCD-）。在2008年至2015年期间接受了第一次NMC/RIC allo-HCT的成年DLBCL患者被纳入研究。单倍体hct的接受者仅限于接受PTCy预防移植物抗宿主病（GVHD）的患者。MSD患者的GVHD预防仅限于基于钙调磷酸酶抑制剂（CNI）的方法，不含体内TCD，而MUD患者接受基于CNI的预防，有或没有TCD。计算了总生存期（OS）和无进展生存期（PFS）、非复发死亡率（NRM）和疾病复发/进展的结局分析。共纳入1438例患者（haplo， 132例；MSD， 525例；MUD TCD+， 403例；MUD TCD-， 378例）。单倍体供体患者明显比MSD和MUD患者年龄更大，表现状态更好，更频繁地接受基于全身照射的调理方案和骨髓移植，TCD+或TCD-。单倍hct后的3年OS、PFS、NRM和复发/进展发生率分别为46%、38%、22%和41%，多因素分析显示与匹配供体移植的结果无显著差异。与MSD、MUD TCD+/TCD-相比，haplol - hct与慢性GVHD的累积发病率较低相关。NMC/RIC单倍hct联合PTCy似乎是DLBCL患者考虑进行同种异体hct但缺乏匹配供体的一个有价值的选择。
This study retrospectively compared long-term outcomes of nonmyeloablative/reduced intensity conditioning (NMC/RIC) allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical family donor (haplo-HCT) using posttransplant cyclophosphamide (PTCy) with those of matched sibling donor (MSD) and matched unrelated donor (MUD) with or without T-cell depletion (TCD+/TCD-) in patients with relapsed diffuse large B-cell lymphoma (DLBCL). Adult patients with DLBCL who had undergone their first NMC/RIC allo-HCT between 2008 and 2015 were included. Recipients of haplo-HCT were limited to those receiving graft-versus-host disease (GVHD) prophylaxis with PTCy. GVHD prophylaxis in MSD was limited to calcineurin inhibitor (CNI)-based approaches without in vivo TCD, while MUD recipients received CNI-based prophylaxis with or without TCD. Outcome analyses for overall survival (OS) and progression-free survival (PFS), nonrelapse mortality (NRM), and disease relapse/progression were calculated. A total of 1438 patients (haplo, 132; MSD, 525; MUD TCD+, 403; and MUD TCD-, 378) were included. Patients with haplo donors were significantly older, had a better performance status and had more frequently received total body irradiation-based conditioning regimens and bone marrow grafts than MSD and MUD TCD+ or TCD-. 3-year OS, PFS, NRM and relapse/progression incidence after haplo-HCT was 46%, 38%, 22%, and 41%, respectively, and not significantly different from outcomes of matched donor transplants on multivariate analyses. Haplo-HCT was associated with a lower cumulative incidence of chronic GVHD compared with MSD, MUD TCD+/TCD-. NMC/RIC haplo-HCT with PTCy seems to be a valuable alternative for patients with DLBCL considered for allo-HCT but lacking a matched donor.