Donor, recipient, and transplant characteristics as risk factors after unrelated donor PBSC transplantation: beneficial effects of higher CD34+ cell dose
Donor, recipient, and transplant characteristics as risk factors after unrelated donor PBSC transplantation: beneficial effects of higher CD34+ cell dose
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DOI：
10.1182/blood-2009-03-208355
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发表时间：
2009-09-24
期刊：
影响因子：
20.3
通讯作者：
Confer, Dennis L.
中科院分区：
文献类型：
--
作者：
Pulsipher, Michael A.;Chitphakdithai, Pintip;Confer, Dennis L.
我们报告了1999年至2003年参加国家骨髓捐献者计划前瞻性试验的932例接受非亲缘供者外周血造血干细胞移植（URD-PBSC HCT）治疗急性髓细胞白血病、急性淋巴细胞白血病、慢性髓细胞白血病和骨髓增生异常综合征的受者的结局。治疗方案包括清髓性（MA; N = 611）、低强度（RI; N = 160）和非清髓性（NMA; N = 161）。对于MA受者，CD 34（+）计数大于3.8 × 10（6）/kg可改善中性粒细胞和血小板植入，而当CD 34（+）细胞剂量超过4.5 × 10（6）/kg时，所有准备方案均可观察到总生存期（OS）改善和移植相关死亡率（TRM）降低。更高剂量的CD 34（+）细胞输注并不会导致急性或慢性移植物抗宿主病（GVHD）的发生率增加。接受MA、RI和NMA方法的患者的3年OS和无病生存率（DFS）相似（分别为33%、35%和32% OS; 33%、30%和29% DFS）。总之，接受不同强度的准备方案的URD-PBSC HCT的接受者经历了相似的生存期。更高的CD 34（+）细胞剂量导致更快的植入，更少的TRM和更好的3年OS（39% vs 25%，MA，P = 0.004; 38% vs 21% RI/NMA，P = 0.004），但不增加GVHD的风险。该试验在www.clinicaltrials.gov上注册为#NCT 00785525。（血。2009; 114：2606-2616）
We report outcomes of 932 recipients of unrelated donor peripheral blood stem cell hematopoietic cell transplantation (URD-PBSC HCT) for acute myeloid leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, and myelodysplastic syndrome enrolled on a prospective National Marrow Donor Program trial from 1999 through 2003. Preparative regimens included myeloablative (MA; N = 611), reduced-intensity (RI; N = 160), and nonmyeloablative (NMA; N = 161). For MA recipients, CD34(+) counts greater than 3.8 X 10(6)/kg improved neutrophil and platelet engraftment, whereas improved overall survival (OS) and reduced transplant-related mortality (TRM) were seen for all preparative regimens when CD34(+) cell doses exceeded 4.5 X 10(6)/kg. Higher infused doses of CD34(+) cell dose did not result in increased rates of either acute or chronic graft-versus-host disease (GVHD). Three-year OS and disease-free survival (DFS) of recipients of MA, RI, and NMA approaches were similar (33%, 35%, and 32% OS; 33%, 30%, and 29% DFS, respectively). In summary, recipients of URD-PBSC HCT receiving preparative regimens differing in intensity experienced similar survival. Higher CD34(+) cell doses resulted in more rapid engraftment, less TRM, and better 3-year OS (39% versus 25%, MA, P = .004; 38% versus 21% RI/NMA, P = .004) but did not increase the risk of GVHD. This trial was registered at www.clinicaltrials.gov as #NCT00785525. (Blood. 2009; 114: 2606-2616)