Comparison of reduced-intensity/toxicity conditioning regimens for umbilical cord blood transplantation for lymphoid malignancies
Comparison of reduced-intensity/toxicity conditioning regimens for umbilical cord blood transplantation for lymphoid malignancies
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脐带血移植治疗淋巴恶性肿瘤的降低强度/毒性预处理方案的比较
DOI：
10.1038/s41409-020-0905-6
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发表时间：
2020
影响因子：
4.8
通讯作者：
Kanda Junya
中科院分区：
文献类型：
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作者：
Imahashi Nobuhiko;Terakura Seitaro;Kondo Eisei;Kako Shinichi;Uchida Naoyuki;Kobayashi Hikaru;Inamoto Yoshihiro;Sakai Hitoshi;Tanaka Masatsugu;Ishikawa Jun;Kozai Yasuji;Matsuoka Ken-ichi;Kimura Takafumi;Fukuda Takahiro;Atsuta Yoshiko;Kanda Junya
为了研究哪种低强度预处理（RIC）/低毒性预处理（RTC）在淋巴系统恶性肿瘤的脐带血移植（UCBT）中具有上级优势，我们回顾性比较了三种广泛使用的RIC/RTC方案：氟达拉滨/美法仑/全身照射（FM-TBI，n= 524），氟达拉滨/环磷酰胺/全身照射（FC-TBI，n= 96）和氟达拉滨/白消安/全身照射或美法仑（基于FB，n= 159）。在急性淋巴细胞白血病（ALL）患者（n= 314）中，预处理方案的总生存期（OS）无差异。在465例恶性淋巴瘤（ML）患者中，FM-TBI和FC-TBI方案的OS相似，而FB方案的OS低于FM-TBI方案（HR为1.73，P< 0.01），原因是其非复发死亡率较高（HR为1.72，P= 0.02）。此外，在接受FM-TBI（HR，0.65;P= 0.03）和FC-TBI（HR，0.25;P< 0.01）方案的患者中，由于复发风险降低，含吗替麦考酚酯的GVHD预防与含甲氨蝶呤的GVHD预防相比具有更好的OS相关。总之，我们的研究结果表明，所有三种RIC/RTC方案在ALL中具有可比的临床结局，而FM-TBI或FC-TBI方案联合含吗替麦考酚酯的GVHD预防在RIC/RTC-UCBT治疗ML中更可取。需要进行大型前瞻性研究来证实这些结果。
To investigate which reduced-intensity conditioning (RIC)/reduced-toxicity conditioning (RTC) is superior for umbilical cord blood transplantation (UCBT) for lymphoid malignancies, we retrospectively compared three widely used RIC/RTC regimens: fludarabine/melphalan/total body irradiation (FM-TBI,n= 524), fludarabine/cyclophosphamide/total body irradiation (FC-TBI,n= 96), and fludarabine/busulfan/total body irradiation or melphalan (FB-based,n= 159). Among patients with acute lymphoblastic leukemia (ALL) (n= 314), there were no differences in overall survival (OS) by conditioning regimen. Among patients with malignant lymphoma (ML) (n= 465), FM-TBI and FC-TBI regimens had similar OS, whereas FB-based regimen had lower OS (hazard ratio [HR], 1.73;P< 0.01) than did FM-TBI regimen due to higher non-relapse mortality (HR, 1.72;P= 0.02). In addition, mycophenolate mofetil-containing GVHD prophylaxis was associated with better OS than methotrexate-containing GVHD prophylaxis among patients who received FM-TBI (HR, 0.65;P= 0.03) and FC-TBI (HR, 0.25;P< 0.01) regimens due to a decreased relapse risk. In summary, our results suggest that all three RIC/RTC regimens have comparable clinical outcomes in ALL, while the FM-TBI or FC-TBI regimens combined with mycophenolate mofetil-containing GVHD prophylaxis is preferable in RIC/RTC-UCBT for ML. Large prospective studies are warranted to confirm these results.