Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated versus matched sibling donor transplantation
Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated versus matched sibling donor transplantation
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DOI：
10.1182/blood.v99.6.1971
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发表时间：
2002-03-15
期刊：
影响因子：
20.3
通讯作者：
McGlave, P
中科院分区：
文献类型：
--
作者：
Weisdorf, DJ;Anasetti, C;McGlave, P
同种异体骨髓移植（BMT）是治疗慢性骨髓性白血病的唯一方法。我们比较了2464例非亲属供体（URD）移植和450例hla相同、匹配的兄弟姐妹供体（MSD）移植在合作的国家骨髓供体计划机构进行的前瞻性收集的结果。共有63%的urd在HLA-A、-B和-DRB1等位基因上匹配；所有MSDs在主要组织相容性位点的基因典型相同。URD患者比msd患者更年轻（中位36 vs 39， P = .001），并且在诊断后更晚接受BMT（中位17[0-325个月]vs 7[1-118个月]，P = .001），并且在慢性期（CP）更少（67% vs 82%, P = .001）。多变量分析显示，URD BMT后移植失败和急性移植物抗宿主病的风险显著增加，匹配URD或MSD移植后血液学复发的风险较低。我们观察到URD移植后明显较差的生存和无病生存（DFS）。然而，对于诊断后1年内在CP期间接受移植的患者，匹配URD与MSD移植后的5年DFS相似或仅略低于（年龄< 30岁：URD 61% +/- 8% vs MSD 68% +/- 15%， P = 0.18； 30-40岁：URD 57% +/- 9% vs MSD 67% +/- 10%， P = 0.05； 40岁：URD 46% +/- 9% vs MSD 57% +/- 9%， P = 0.02）。CP患者从诊断到BMT的延迟导致匹配URD后的5年DFS明显低于MSD BMT （CP 1-2年：URD 39% +/- 6% vs MSD 63% +/- 12%； 2年以上：URD 33% +/- 7% vs MSD 50% +/- 20%）。早期CP慢性骨髓性白血病匹配URD BMT的存活率和DFS接近MSD移植。然而，延迟可能在更大程度上损害URD的结果。URD和MSD移植仍然需要改进，更新的非移植疗法的结果应该与URD和MSD骨髓移植的既定治疗潜力进行评估。
Allogeneic bane marrow transplantation (BMT) offers the only curative therapy for chronic myelogenous leukemia. We compared prospectively collected results of 2464 unrelated donor (URD) transplantations with 450 HLA-identical, matched sibling donor (MSD) transplantations performed at collaborating National Marrow Donor Program institutions. A total of 63% of URDs were matched at HLA-A, -B, and at -DRB1 alleles; all MSDs were genotypically identical at major histocompatibility loci. URD recipients were younger (median 36 vs 39, P = .001) than MSDs and underwent BMT later after diagnosis (median 17 [0-325 months] vs 7 [1-118 months], P = .001) and less often in chronic phase (CP) (67% vs 82%, P = .001). Multivariate analysis demonstrated a significantly increased risk of graft failure and acute graft versus host disease after URD BMT The risk of hematologic relapse was low after either matched URD or MSD transplantations. We observed significantly though modestly poorer survival and disease-free survival (DFS) after URD transplantations. However, for those undergoing transplantation during CP within 1 year from diagnosis, 5-year DFS was similar or only slightly inferior after matched URD versus MSD transplantation (age < 30: URD 61% +/- 8% vs MSD 68% +/- 15%, P = .18; 30-40: URD 57% +/- 9% vs MSD 67% +/- 10%, P = .05; > 40: URD 46% +/- 9% vs MSD 57% +/- 9%, P = .02). Delay from diagnosis to BMT in CP patients led to substantially poorer 5-year DFS after matched URD than MSD BMT (CP 1-2 years: URD 39% +/- 6% vs MSD 63% +/- 12%; beyond 2 years: URD 33% +/- 7% vs MSD 50% +/- 20%). Outcome of matched URD BMT for early CP chronic myelogenous leukemia yields survival and DFS approaching that of MSD transplantation. However, delay may compromise URD outcomes to a greater extent. Improvements in URD and MSD transplantation are still needed, and results of newer, nontransplantation therapies should be evaluated against the established curative potential of URD and MSD marrow transplantation.