Promising Progression-Free Survival for Patients Low and Intermediate Grade Lymphoid Malignancies after Nonmyeloablative Umbilical Cord Blood Transplantation
Promising Progression-Free Survival for Patients Low and Intermediate Grade Lymphoid Malignancies after Nonmyeloablative Umbilical Cord Blood Transplantation
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DOI：
10.1016/j.bbmt.2008.11.013
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发表时间：
2009-02-01
影响因子：
4.3
通讯作者：
Wagner, John E.
中科院分区：
文献类型：
--
作者：
Brunstein, Claudio G.;Cantero, Susano;Wagner, John E.
非清髓性造血细胞移植（HCT）已被用于治疗晚期或高危淋巴恶性肿瘤患者。我们研究了65名接受脐带血移植的患者（中位年龄46岁），这些患者接受了一种单一的预处理方案，包括第-6天环磷酰胺（50 mg/kg），第-6天至第-2天氟达拉滨（40 mg/m2），以及单次全身照射（TBI）（200 cGy）沿着环孢素霉酚酸酯免疫抑制剂。中性粒细胞和血小板恢复的中位时间分别为7.5天（范围：0-32）和46天（范围：8-111）。II-IV级、III-IV级急性和慢性移植物抗宿主病（aGVHD、cGVHD）的累积发生率分别为57%（95%置信区间[CI]：43%-70%）、25%（95% CI：14%-35%）和19%（95% CI：9%-29%）。3年时移植相关死亡率为15%（95% CI 5%-26%）。中位随访时间为23个月。3年时无进展生存期（PFS）、当前PFS和总生存期（OS）分别为34%（95% CI：21%-47%）、49%（95% CI：36%-62%）和55%（95% CI：42%-70%）。根据我们的数据，我们得出结论，非清髓性预处理方案，其次是脐血移植是一种有效的治疗晚期淋巴系统恶性肿瘤患者谁缺乏一个合适的同胞供体。
Nonmyeloablative hematopoietic cell transplantation (HCT) has been used to treat patients with advanced or high-risk lymphoid malignancies. We studied 65 patients (median age 46 years) receiving an umbilical cord blood (UCB) graft after a single conditioning regimen consisting of cyclophosphamide (50 mg/kg) on day -6, fludarabine (40 mg/m(2)) daily on days -6 to -2, as well as a single fraction of total-body irradiation (TBI) (200 cGy) along with cyclosporine mycophenolate mofetil immunosuppression. Median time to neutrophil and platelet recovery was 7.5 days (range: 0-32) and 46 days (range: 8-111), respectively. Cumulative incidences of grade II-IV, grade III-IV acute, and chronic graft-versus-host disease (aGVHD, cGVHD) were 57% (95% confidence interval [Cl]: 43%-70%), 25% (95% Cl: 14%-35%), and 19% (95% Cl: 9%-29%), respectively. Transplant-related mortality at 3 years was 15% (95% Cl 5%-26%). Median follow-up was 23 months. The progression free-survival (PFS), current PFS and overall survival (OS) were 34% (95% Cl: 21%-47%), 49% (95% Cl: 36%-62%), and 55% (95% Cl: 42%-70%) at 3 years. Based on our data, we conclude that a nonmyeloablative conditioning regimen followed by UCB transplantation is an effective treatment for patients with advanced lymphoid malignancies who lack a suitable sibling donor.