In vivo T cell depletion with pretransplant anti-thymocyte globulin reduces graft-versus-host disease without increasing relapse in good risk myeloid leukemia patients after stem cell transplantation from matched related donors
In vivo T cell depletion with pretransplant anti-thymocyte globulin reduces graft-versus-host disease without increasing relapse in good risk myeloid leukemia patients after stem cell transplantation from matched related donors
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DOI：
10.1038/sj.bmt.1703530
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发表时间：
2002-04-01
影响因子：
4.8
通讯作者：
Zander, AR
中科院分区：
文献类型：
--
作者：
Kröger, N;Zabelina, T;Zander, AR
102例高危髓系白血病患者（CML第一慢性期或AML第一CR）在用（n = 45）或不用抗胸腺细胞球蛋白（ATG）（n = 57）预处理后从HLA相关供体移植。在非ATG组中观察到一例移植物失效，而在ATG组中未观察到一例。白细胞植入（>1 × 10（9）/l）的中位时间在ATG组为16天（范围12-33），在非ATG组（NS）为17天（范围11-29），血小板植入（>20 × 10（9）/l）的中位时间分别为24天和19天（P = 0.002）。在非ATG组和ATG组中分别有47%和20%的患者发生了II-IV级急性GVHD（P = 0.004）。ATG组和非ATG组的III/IV级GVHD发生率分别为7%和32%（P = 0.002）。慢性GVHD分别为36%和67%（P = 0.005）。中位随访48个月（范围2-128）后，ATG组的5年估计OS为66%（95% KI：51-81%），非ATG组（NS）为59%（95% KI：46-72%）。ATG方案的5年估计DFS为64%（95% KI：50-78%），非ATG方案（NS）的5年估计DFS为55%（95% KI：43-67%）。ATG组的5年复发概率为5%，非ATG组（NS）为15%。ATG作为预处理方案的一部分，可显著降低HLA相关供者干细胞移植后髓系白血病患者的GVHD，而不增加复发率。
One-hundred and two patients with good risk myeloid leukemia (CML first chronic phase or AML first CR) were transplanted from HLA-related donors after conditioning with (n = 45) or without anti-thymocyte globulin (ATG) (n = 57). One graft failure was observed in the non-ATG and none in the ATG group. The median time to leukocyte engraftment (>1 X 10(9)/l) was 16 (range 12-33) in the ATG group and 17 days (range 11-29) in the non-ATG group (NS) and for platelet engraftment (>20 X 10(9)/l) 24 and 19 days (P = 0.002), respectively. Acute GVHD grade II-IV was observed in 47% of the non-ATG and in 20% of the ATG group (P = 0.004). Grade III/IV GVHD occurred in 7% of the ATG and in 32% of the non-ATG group (P = 0.002). Chronic GVHD was seen in 36% and 67% (P = 0.005), respectively. After a median follow-up of 48 months (range 2-128), the 5-year estimated OS is 66% (95% KI: 51-81%) for the ATG group and 59% (95% KI: 46-72%) for the non-ATG group (NS). The 5-year estimated DFS is 64% (95% KI: 50-78%) for ATG and 55% (95% KI: 43-67%) for the non-ATG regimen (NS). The 5-year probability of relapse was 5% in the ATG and 15% in the non-ATG group (NS). ATG as part of the conditioning regimen leads to a significant reduction in GVHD without increase of relapse in patients with myeloid leukemia after stem cell transplantation from HLA-related donors.