Significant Improvement in Survival After Allogeneic Hematopoietic Cell Transplantation During a Period of Significantly Increased Use, Older Recipient Age, and Use of Unrelated Donors
Significant Improvement in Survival After Allogeneic Hematopoietic Cell Transplantation During a Period of Significantly Increased Use, Older Recipient Age, and Use of Unrelated Donors
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DOI：
10.1200/jco.2012.46.6193
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发表时间：
2013-07-01
影响因子：
45.3
通讯作者：
Majhail, Navneet S.
中科院分区：
文献类型：
--
作者：
Hahn, Theresa;McCarthy, Philip L., Jr.;Majhail, Navneet S.
目的在过去的四十年里，异基因造血细胞移植（alloHCT）已发展成为血液病患者的一种治疗方式。这项研究描述了在使用，技术和生存率的变化，在人口为基础的队列。从1994年到2005年，在美国或加拿大中心首次接受alloHCT并报告给国际血液和骨髓移植研究中心的060例血液恶性肿瘤或疾病患者。骨髓性白血病（AML）、骨髓增生异常综合征（MDS）以及霍奇金和非霍奇金淋巴瘤增加了45%，从每年2，520例增加到3，668例。从1994年到2005年，外周血（7%到6%）和脐带血（2%到10%）的使用都有所增加，而骨髓的使用则有所下降（90%到27%）。尽管中位年龄从33岁增加到40岁，无关供者的alloHCT增加了%，但清髓性同胞alloHCT后首次完全缓解的AML患者第100天的总生存期（OS）显著改善（85%至94%; P < .001）和无关的alloHCT（63%至86%; P < .001）;接受无关alloHCT的患者1年OS改善（48%至63%; P = 0.003），但在接受同胞alloHCT的患者中没有。ALL和MDS的结果相似。AML、ALL、MDS和慢性粒细胞白血病在脐带血alloHCT后第100天的OS从60%显著改善至78%（P <0.001）。使用降低强度的方案增加，产生OS率类似于那些清髓性regiments.Conclusion生存的那些接受alloHCT随着时间的推移显着改善。然而，需要新的方法来进一步提高1年OS。
Purpose Over the past four decades, allogeneic hematopoietic cell transplantation (alloHCT) has evolved as a curative modality for patients with hematologic diseases. This study describes changes in use, technique, and survival in a population-based cohort.Patients and Methods The study included 38,060 patients with hematologic malignancies or disorders who underwent first alloHCT in a US or Canadian center from 1994 to 2005 and were reported to the Center for International Blood and Marrow Transplant Research.Results AlloHCT as treatment for acute lymphoblastic (ALL) and myeloid leukemias (AML), myelodysplastic syndrome (MDS), and Hodgkin and non-Hodgkin lymphomas increased by 45%, from 2,520 to 3,668 patients annually. From 1994 to 2005, use of both peripheral (7% to 6%) and cord blood increased (2% to 10%), whereas use of marrow decreased (90% to 27%). Despite a median age increase from 33 to 40 years and % increase in unrelated donors for alloHCT, overall survival (OS) at day 100 significantly improved for patients with AML in first complete remission after myeloablative sibling alloHCT (85% to 94%; P < .001) and unrelated alloHCT (63% to 86%; P < .001); 1-year OS improved among those undergoing unrelated alloHCT (48% to 63%; P = .003) but not among those undergoing sibling alloHCT. Similar results were seen for ALL and MDS. Day-100 OS after cord blood alloHCT improved significantly from 60% to 78% (P < .001) for AML, ALL, MDS, and chronic myeloid leukemia. Use of reduced-intensity regimens increased, yielding OS rates similar to those of myeloablative regimens.Conclusion Survival for those undergoing alloHCT has significantly improved over time. However, new approaches are needed to further improve 1-year OS.