Stem cell transplantation from a haploidentical donor versus a genoidentical sister for adult male patients with acute myelogenous leukemia in first remission: A retrospective study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation
Stem cell transplantation from a haploidentical donor versus a genoidentical sister for adult male patients with acute myelogenous leukemia in first remission: A retrospective study from the acute leukemia working party of the European Society for Blood and Marrow Transplantation
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DOI：
10.1002/cncr.32629
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发表时间：
2019-11-27
期刊：
影响因子：
6.2
通讯作者：
Mohty, Mohamad
中科院分区：
文献类型：
--
作者：
Gorin, Norbert-Claude;Labopin, Myriam;Mohty, Mohamad
背景：在成人急性髓系白血病(AML)患者中，匹配的同胞供体(MSD)被认为是异基因移植的首选。然而，对于男性受者来说，女性捐赠者是一个糟糕的预后因素。作者比较了半相合(单倍体)捐献者和女性多发性硬化症。方法总共有834名男性接受了女性MSD的同种异体移植，232名男性接受了单倍体供者的同种异体移植。其中，86%的单倍体受者和3%的MSD受者在移植后接受了大剂量环磷酰胺的移植物抗宿主病(GVHD)预防。供体类型与细胞遗传学之间存在显著的质的交互作用，因此，分析在细胞遗传学上是分层次的。结果在中危AML患者中，638例接受了女性MSD的移植，160例接受了单倍体供者的移植。在多变量分析中，较差的危险因素是单倍体供者与MSD的无复发死亡率(风险比[HR]，1.7；P=0.02)以及患者的年龄(HR，1.22[P=0.02]和1.15[P=0.02])。单倍体移植可减少慢性移植物抗宿主病(HR，0.43；P<；10(-4))，但降低无白血病存活率(HR，1.7；P=0.04)。GVHD/无复发生存率(GRFS)无明显差异。在患有高危AML的男性中，196人接受了女性MSD的移植，72人接受了单倍体捐赠者的移植。经多因素分析，单纯性白血病患者的复发率较低(HR，0.40；P=0.004)，无白血病生存率较好(HR，0.46，P=0.003)，总生存率较好(HR，0.43，P=0.003)，GRFS较好(HR，0.54，P=0.006)。结论：在患有中等风险AML的男性中，姐妹MSD或单倍体供者的同种异体移植会产生类似的GRFS。然而，对于患有高危AML的男性，单核细胞供者联合预防性大剂量环磷酰胺移植后可能是更好的选择。
Background In adult patients with acute myeloid leukemia (AML), a matched sibling donor (MSD) is considered the first choice for an allogeneic transplantation. However, a female donor for a male recipient is a poor prognostic factor. The authors compared haploidentical (HAPLO) donors with female MSDs. Methods In total, 834 men underwent allogenic transplantation from a female MSD, and 232 men underwent allogenic transplantation from a HAPLO donor. Of these, 86% of HAPLO recipients and 3% of MSD recipients received graft-versus-host disease (GVHD) prophylaxis posttransplantation with high-dose cyclophosphamide. A significant qualitative interaction was observed between donor type and cytogenetics, Therefore, the analyses were stratified on cytogenetics. Results Of the men with intermediate-risk AML, 638 received transplantation from a female MSD, and 160 received transplantation from a HAPLO donor. In multivariate analysis, poor risk factors were a HAPLO donor versus an MSD for nonrelapse mortality (hazard ratio [HR], 1.7; P = .02) and patient age for nonrelapse mortality and overall survival (HR, 1.22 [P = .02] and 1.15 [P = .02], respectively). HAPLO transplantation resulted in less chronic GVHD (HR, 0.43; P < 10(-4)) but lower leukemia-free survival (HR, 1.7; P = .04). The GVHD/relapse-free survival (GRFS) was not different. Of the men with high-risk AML, 196 received transplantation from a female MSD, and 72 received transplantation from a HAPLO donor. By multivariate analysis, HAPLO recipients had a lower incidence of relapse (HR, 0.40; P = .004), better leukemia-free survival (HR, 0.46; P = .003), better overall survival (HR, 0.43; P = .003), and better GRFS (HR, 0.54; P = .006). Conclusions In men who have intermediate-risk AML, allogenic transplantation from a sister MSD or a HAPLO donor produces similar GRFS. However, in men who have high-risk AML, a HAPLO donor combined with prophylactic high-dose cyclophosphamide posttransplantation may be a better choice.