Reduced-intensity versus myeloablative conditioning in cord blood transplantation for AML (40-60 years) across highly mismatched HLA barriers - On behalf of Eurocord and the Cellular Therapy & Immunobiology Working Party (CTIWP) of EBMT.
Reduced-intensity versus myeloablative conditioning in cord blood transplantation for AML (40-60 years) across highly mismatched HLA barriers - On behalf of Eurocord and the Cellular Therapy & Immunobiology Working Party (CTIWP) of EBMT.
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跨越高度不匹配的 HLA 屏障的 AML（40-60 岁）脐带血移植中的降低强度与清髓调理 - 代表 Eurocord 和细胞疗法
DOI：
10.1016/j.bbmt.2020.07.025
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
A. Ruggeri
中科院分区：
文献类型：
--
作者：
V. Sheth;F. Volt;J. Sanz;L. Clément;J. Cornelissen;D. Blaise;J. Sierra;M. Michallet;R. Saccardi;V. Rocha;E. Gluckman;C. Chabannon;A. Ruggeri
在脐带血移植（UCBT）中使用清髓调节（MAC）与bb0 - 40岁患者的高非复发死亡率（NRM）相关，特别是那些HLA差异高的患者，因此限制了更广泛的应用。我们假设降低强度调节（RIC）的NRM优势和与HLA差异较大相关的更高移植物抗白血病效应将扩大其在40至60岁患者中的应用，而不会影响疗效，并比较RIC和MAC方案之间的结果。共纳入288例年龄在40 - 60岁之间的新生急性髓性白血病患者，接受UCBT且至少有2个HLA与RIC （n = 166）或MAC （n = 122）方案不匹配。与RIC相比，MAC队列包括相对年轻的患者，他们接受了更多的单UCBT，有核细胞总数更低，体内T细胞消耗更多。到中性粒细胞植入、感染（细菌、病毒和真菌）以及II至IV级急性和慢性移植物抗宿主病的中位时间在两组中相似。在多因素分析中，RIC和MAC的总生存率（风险比[HR]， 0.98；P= .9）、NRM（风险比[HR]， 0.68；P= .2）和复发率（风险比[HR]， 1.24；P= .5）无显著差异。难治性疾病与较差的生存率相关。对于年龄在40 - 60岁且HLA错配≥2的患者，在RIC或MAC方案后，UBCT的结果具有可比性。
The use of myeloablative conditioning (MAC) in umbilical cord blood transplantation (UCBT) has been associated with high nonrelapse mortality (NRM) in patients aged >40 years, especially those having a high HLA disparity, thus limiting wider applications. We hypothesized that the NRM advantage of reduced-intensity conditioning (RIC) and higher graft-versus-leukemia effect associated with greater HLA disparities would expand its use for patients (aged 40 to 60 years) without compromising efficacy and compared outcomes between RIC and MAC regimens. In total, 288 patients aged 40 to 60 years, with de novo acute myeloid leukemia, receiving UCBT with at least 2 HLA mismatches with RIC (n = 166) or MAC (n = 122) regimens were included. As compared to RIC, the MAC cohort included relatively younger patients, having received more single UCBT, with lower total nucleated cell counts and more in vivo T cell depletion. Median time to neutrophil engraftment, infections (bacterial, viral, and fungal), and grade II to IV acute and chronic graft-versus-host disease were similar in both groups. In the multivariate analysis, overall survival (hazard ratio [HR], 0.98;P= .9), NRM (HR, 0.68;P= .2), and relapse (HR, 1.24;P= .5) were not different between RIC and MAC. Refractory disease was associated with worse survival. Outcomes of UBCT for patients aged 40 to 60 years having ≥2 HLA mismatches are comparable after the RIC or MAC regimen.
影响因子：
20.3
作者：
Eapen, Mary;Klein, John P.;Rocha, Vanderson
通讯作者：
Rocha, Vanderson
影响因子：
11.4
作者：
Kanda, Junya;Hayashi, Hiromi;Gluckman, Eliane
通讯作者：
Gluckman, Eliane