Reduced-intensity conditioning by fludarabine/busulfan without additional irradiation or T-cell depletion leads to low non-relapse mortality in unrelated bone marrow transplantation
Reduced-intensity conditioning by fludarabine/busulfan without additional irradiation or T-cell depletion leads to low non-relapse mortality in unrelated bone marrow transplantation
复制标题
在不进行额外照射或 T 细胞耗竭的情况下，使用氟达拉滨/白消安降低强度调节可降低无关骨髓移植中的非复发死亡率
DOI：
10.1007/s12185-011-0805-z
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发表时间：
2011
期刊：
影响因子：
2.1
通讯作者：
Hino M
中科院分区：
文献类型：
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作者：
Nakane T;Nakamae H;Koh H;Nakamae M;Hayashi Y;Nishimoto M;Yoshimura T;Inoue E;Inoue A;Aimoto R;Aimoto M;Terada Y;Koh KR;Yamane T;Hino M
在降低的强度下，来自无关供体的异基因干细胞移植（u-RIST）、移植物抗宿主病（GVHD）、移植物衰竭和非复发死亡率（NRM）是持续存在的问题。尽管抗胸腺细胞球蛋白、阿仑单抗和全身照射（TBI）已被探索作为u-RIST的预处理方式，但尚未确定T细胞耗竭或TBI预防GVHD或促进u-RIST植入的必要性。我们在这里报告了使用u-RIST与骨髓移植后，一个简单的预处理方案180毫克/m2氟达拉滨和8毫克/公斤的口服或静脉注射白消安没有TBI或T细胞耗竭。研究人群仅为既往有化疗史的日本患者。我们回顾性分析了31例连续患者（中位年龄53岁）。25例患者（81%）移植自HLA-A、-B和-DRB 1等位基因匹配的供体。在所有患者中，均实现了中性粒细胞植入。II-IV级急性GVHD的累积发生率为42%。然而，77%的急性GVHD患者在最初的、全身的、高剂量的类固醇治疗后得到改善，并且可以通过这种治疗来控制。两年总生存率和无事件生存率分别为62%和53%。2年时10%的NRM相对较低。我们的研究结果表明，在某些患者群体中，无TBI或T细胞耗竭的u-RIST可能改善u-RIST后的预后。
In reduced intensity, allogeneic stem cell transplantation from unrelated donors (u-RIST), graft-versus-host disease (GVHD), graft failure, and non-relapse mortality (NRM) are persistent problems. Although anti-thymocyte globulin, alemtuzumab, and total body irradiation (TBI) have been explored as conditioning modalities for u-RIST, the necessity for T-cell depletion or TBI to prevent GVHD or facilitate engraftment in u-RIST has not been determined. We here report the use of u-RIST with bone marrow grafting, following a simple conditioning regimen of 180 mg/m2fludarabine and 8 mg/kg of oral or intravenous busulfan without TBI or T-cell depletion. The study population was exclusively Japanese patients with a history of prior chemotherapy. We retrospectively analyzed 31 consecutive patients (median age 53 years). Twenty-five patients (81%) were transplanted from HLA-A, -B, and -DRB1 allele-matched donors. In all patients, neutrophil engraftment was achieved. The cumulative incidence of grade II–IV acute GVHD was 42%. However, 77% of patients with acute GVHD improved with, and could be managed by, initial, systemic, high-dose steroid treatment alone. Two-year overall and event-free survival was 62 and 53%, respectively. The NRM of 10% at 2 years was relatively low. Our results suggest that u-RIST without TBI or T-cell depletion may improve the prognosis after u-RIST in certain patient populations.