Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia
Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia
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DOI：
10.1182/blood-2015-04-639831
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发表时间：
2015-08-20
期刊：
影响因子：
20.3
通讯作者：
Eapen, Mary
中科院分区：
文献类型：
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作者：
Ciurea, Stefan O.;Zhang, Mei-Jie;Eapen, Mary
我们在单倍同变（n = 192）和8/8 HLA无关的供体（n = 1982）移植后研究了急性髓样白血病（AML）的成年人。单倍性接受者接受了钙调神经蛋白抑制剂（CNI），霉酚酸盐和移植后环磷酰胺的治疗，用于移植物抗宿主病（GVHD）的预防； 104例患者接受了骨髓性，88例接受了强度调节方案。匹配的无关供体移植受者接受了霉酚酸盐或甲氨蝶呤的GVHD预防的CNI； 1245例患者患有骨髓性，737例接受了强度调节方案。与匹配的无关供体移植相比，单倍症后第30天的中性粒细胞恢复较低（90％vs 97％，p = .02）。降低强度调节移植后的相应速率为93％和96％（p = .25）。在骨髓性的环境中，与匹配相比，单倍型相比，在骨髓均3个月急性2-4级（16％vs 33％，p <.0001）和3年慢性GVHD（30％vs 53％，p <.0001）较低无关的供体移植。在降低强度调节移植后观察到类似的差异，19％对28％（P = .05）和34％vs 52％（p = .002）。在接受脊全治疗方案的患者中，在单倍耐发现和匹配的无关供体移植（p5.38）之后，总生存期的3年概率为45％（95％CI，36-54）和50％（95％CI，47-53）。降低强度调节移植后的相应速率为46％（95％CI，35-56）和44％（95％CI，0.40-47）（p = .71）。尽管有限的统计Poweris有限，但这些数据表明，用移植后环磷酰胺进行单倍体移植后AML患者的存活率与匹配的无关供体移植相当。
We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P5.38). Corresponding rates after reduced intensity conditioning transplants were 46%(95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical poweris limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.