Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study
Transplantation of allogeneic hematopoietic stem cells for adult T-cell leukemia: a nationwide retrospective study
复制标题
DOI：
10.1182/blood-2009-10-247510
复制
发表时间：
2010-08-26
期刊：
影响因子：
20.3
通讯作者：
Uchiyama, Takashi
中科院分区：
文献类型：
--
作者：
Hishizawa, Masakatsu;Kanda, Junya;Uchiyama, Takashi
异基因造血干细胞移植（HSCT）越来越多地用作成人T细胞白血病（ATL）的治疗选择，ATL是一种与人类T细胞白血病病毒I型（HTLV-I）有因果关系的难治性成熟T细胞肿瘤。我们比较了386例ATL患者使用不同移植物来源进行异基因HSCT的结果：154例接受人类白细胞抗原（HLA）匹配的相关骨髓或外周血; 43例接受HLA不匹配的相关骨髓或外周血; 99例接受无关骨髓; 90例接受单单位无关脐带血。中位随访41个月（范围1.5-102）后，整个队列的3年总生存率为33%（95%置信区间，28%-38%）。多变量分析显示，4个受体因素与较低的生存率显著相关：年龄较大（> 50岁），男性，完全缓解以外的状态，以及与使用HLA匹配的相关移植物相比，使用无关脐带血。接受脐带血移植的患者治疗相关死亡率较高;男性受者或接受移植未缓解的患者疾病相关死亡率较高。在接受相关移植的患者中，供体HTLV-I血清阳性对疾病相关死亡率有不利影响。总之，使用目前可用的移植物来源的同种异体HSCT是治疗选定的ATL患者的有效方法，尽管需要更大的努力来降低治疗相关的死亡率。（血。2010; 116（8）：1369-1376）
Allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly used as a curative option for adult T-cell leukemia (ATL), an intractable mature T-cell neoplasm causally linked with human T-cell leukemia virus type I (HTLV-I). We compared outcomes of 386 patients with ATL who underwent allogeneic HSCT using different graft sources: 154 received human leukocyte antigen (HLA)-matched related marrow or peripheral blood; 43 received HLA-mismatched related marrow or peripheral blood; 99 received unrelated marrow; 90 received single unit unrelated cord blood. After a median follow-up of 41 months (range, 1.5-102), 3-year overall survival for entire cohort was 33% (95% confidence interval, 28%-38%). Multivariable analysis revealed 4 recipient factors significantly associated with lower survival rates: older age (> 50 years), male sex, status other than complete remission, and use of unrelated cord blood compared with use of HLA-matched related grafts. Treatment-related mortality rate was higher among patients given cord blood transplants; disease-associated mortality was higher among male recipients or those given transplants not in remission. Among patients who received related transplants, donor HTLV-I seropositivity adversely affected disease-associated mortality. In conclusion, allogeneic HSCT using currently available graft source is an effective treatment in selected patients with ATL, although greater effort is warranted to reduce treatment-related mortality. (Blood. 2010; 116(8): 1369-1376)