Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation
Comparable results in patients with acute lymphoblastic leukemia after related and unrelated stem cell transplantation
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DOI：
10.1038/sj.bmt.1705221
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发表时间：
2006-01-01
影响因子：
4.8
通讯作者：
Zander, AR
中科院分区：
文献类型：
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作者：
Dahlke, J;Kröger, N;Zander, AR
我们报告了84例完全相关(n=46)和非相关(n=38)的同种异体SCT患者的结果。受者平均年龄23岁(范围1-60)，中位随访期18个月(范围1-133)。CR1移植43例，CR2或CR3移植25例，原发难治4例，PR 4例，复发8例。预适应方案包括TBI/VP16/CY(n=76)、TBI/VP16(n=2)、TBI/CY(n=2)、Bu/VP16/CY(n=4)。3年的OS为45%(44%与之无关，46%与之相关)。单因素分析显示年龄<18岁(P=0.03)、性别组合不匹配(P=0.03)患者的OS明显好于非亲缘SCT患者(P=0.03)，两者对非亲缘SCT后OS的影响更大。患者年龄和18岁(P=0.004)、患者巨细胞病毒血清阴性(P=0.014)、女性受者(P=0.04)是影响移植后TRM的因素。两种供体类型组的TRM无显著差异，复发率相似。多因素分析显示，性别组合不匹配(RR：70，95%CI：0.51~0.93，P=0.015)、患者年龄和18岁(RR：0.66，95%CI：0.47~0.93，P=0.016)是导致OS升高的显著因素。女性(RR：0.56，95%CI：0.33~0.98，P=0.042)、CMV阴性患者(RR：0.57，95%CI：0.36~0.90，P=0.015)。无血缘关系的干细胞移植对于高危ALL患者，没有相合的家庭供者是合理的。
We report the results of 84 patients with ALL after related (n = 46) or unrelated (n = 38) allogeneic SCT. Mean recipient age was 23 years (range: 1-60) and median follow-up was 18 months (range: 1-133). Forty-three patients were transplanted in CR1; 25 in CR2 or CR3; four were primary refractory; four in PR; eight in relapse. The conditioning regimen consisted of TBI/ VP16/CY (n = 76), TBI/VP16 (n = 2), TBI/CY (n = 2), Bu/VP16/CY (n = 4). The OS at 3 years was 45% (44% unrelated, 46% related). Univariate analysis showed a significantly better OS for patients < 18 years (P = 0.03), mismatched sex-combination (P = 0.03), both with a stronger effect on increasing OS after unrelated SCT. Factors decreasing TRM were patient age < 18 years (P = 0.004), patient CMV-seronegativity (P = 0.014), female recipient (P = 0.04). There was no significant difference in TRM and the relapse rate was similar in both donor type groups. Multivariate analysis showed that factors for increased OS which remained significant were mismatched sex-combination (RR: 70,95% CI: 0.51-0.93, P = 0.015), patient age < 18 years (RR: 0.66, 95% CI: 0.47-0.93, P = 0.016). A decreased TRM was found for female patients (RR: 0.56, 95% CI: 0.33-0.98, P = 0.042), negative CMV status of the patient ( RR: 0.57, 95% CI: 0.36-0.90, P = 0.015). Unrelated stem cell transplantation for high-risk ALL patients with no HLA-compatible family donor is justifiable.