Influence of Stem Cell Source on Outcomes of Allogeneic Reduced-Intensity Conditioning Therapy Transplants Using Haploidentical Related Donors
Influence of Stem Cell Source on Outcomes of Allogeneic Reduced-Intensity Conditioning Therapy Transplants Using Haploidentical Related Donors
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DOI：
10.1016/j.bbmt.2015.06.006
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发表时间：
2015-09-01
影响因子：
4.3
通讯作者：
Gottlieb, David
中科院分区：
文献类型：
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作者：
Bradstock, Kenneth;Bilmon, Ian;Gottlieb, David
我们比较了2个回顾性队列的患者接受降低强度预处理（RIC）治疗移植，使用单倍体相合的相关供体和移植后预防移植物抗宿主病（GVHD）的高剂量环磷酰胺，他克莫司和霉酚酸酯的结果。第一组13人移植骨髓（BM）作为干细胞来源，而第二组23人使用粒细胞集落刺激因子动员的外周血干细胞（PBSC）。BM队列在第+3天接受60 mg/kg环磷酰胺单次给药，而PBSC队列在第+3天和第+4天接受2次给药。第一队列的患者年龄稍大，急性髓性白血病的比例较高，但两组之间疾病风险指数评分的分布没有差异。PBSC组的患者在干细胞移植物中接受了两倍数量的CD 34（+）细胞。两组间中性粒细胞和血小板恢复时间无差异。PBSC组中有3名患者未能植入，但通过自体造血恢复并存活。BM和PBSC的6个月急性GVHD累积发生率分别为55.1%和48.5%（P = .651），而BM和PBSC的24个月慢性GVHD累积发生率分别为28.6%和323%（P = .685）。只有2例患者，均在BM组，死于非复发原因，均为第二癌症。BM和PBSC的2年累积复发率分别为43.9%和23.5%（P = 0.286）。PBSC患者的2年总生存率明显更高（P = 0.028），为83.4%，BM为52.7%。BM组和PBSC组的无复发和无事件生存率无显著差异。在这项回顾性分析中，我们得出结论，使用PBSC进行单倍体相合RIC移植是一种可行的策略，与BM相比，急性和慢性GVHD的发生率和复发风险相当，非复发死亡率较低。(C)2015年美国血液和骨髓移植协会。
We compared outcomes for 2 retrospective cohorts of patients undergoing reduced-intensity conditioning (RIC) therapy transplants using haploidentical related donors and post-transplant prophylaxis against graft-versus-host disease (GVHD) with high-dose cyclophosphamide, tacrolimus, and mycophenolate. The first cohort of 13 was transplanted with bone marrow (BM) as the stem cell source, whereas the second cohort of 23 used peripheral blood stem cells (PBSCs) mobilized with granulocyte colony-stimulating factor. The BM cohort received a single 60-mg/kg dose of cyclophosphamide on day +3, whereas the PBSC cohort received 2 doses on days +3 and +4. Patients in the first cohort were slightly older and had a higher proportion of acute myeloid leukemia, but there were no differences in the distribution of Disease Risk Index scores between the 2 groups. Patients in the PBSC group received double the number of CD34(+) cells in the stem cell graft. Times to neutrophil and platelet recovery were not different between the 2 groups. Three patients, all in the PBSC group, failed to engraft but recovered with autologous hemopoiesis and survived. The 6-month cumulative incidences of acute GVHD were 55.1% for BM and 48.5% for PBSCs (P = .651), whereas 24-month cumulative rates for chronic GHVD were 28.6% for BM and 323% for PBSCs (P = .685). Only 2 patients, both in the BM group, died of nonrelapse causes, both of second cancers. The 2-year cumulative incidences of relapse were 43.9% for BM and 23.5% for PBSCs (P = .286). Overall survival at 2 years was significantly better for PBSC patients (P = .028), at 83.4% versus 52.7% for BM. Relapse-free and event-free survival did not differ significantly between BM and PBSC groups. In this retrospective analysis, we conclude that the use of PBSCs for haploidentical RIC transplants is a feasible strategy, with equivalent rates of acute and chronic GVHD and risk of relapse and low nonrelapse mortality compared with BM. (C) 2015 American Society for Blood and Marrow Transplantation.