Transplantation of marrow cells from unrelated donors for treatment of high-risk acute leukemia: The effect of leukemic burden, donor HLA-matching, and marrow cell dose
Transplantation of marrow cells from unrelated donors for treatment of high-risk acute leukemia: The effect of leukemic burden, donor HLA-matching, and marrow cell dose
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DOI：
10.1182/blood.v89.11.4226
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发表时间：
1997-06-01
期刊：
影响因子：
20.3
通讯作者：
Anasetti, C
中科院分区：
文献类型：
--
作者：
Sierra, J;Storer, B;Anasetti, C
从HLA相容的无关志愿者移植造血干细胞是缺乏家族匹配的急性白血病患者的一种选择。然而，患者和供体选择的标准以及最有效的移植程序，包括造血细胞的数量，仍有待确定。我们对174例接受非亲缘供者非T细胞耗竭骨髓的原发性急性白血病患者的预后影响因素进行了研究。患者中位年龄为20岁（范围：0.5 - 54岁）。一项多变量分析发现，移植时白血病缓解与无白血病生存率提高相关（治疗失败的相对风险[RR]：0.5，置信区间[CI]：0.3 - 0.7），外周血中存在原始细胞，而不是仅累及骨髓或孤立的髓外复发，与受损的结局相关（治疗失败的RR：2.5，CI：1.7 - 5.0）。与HLA匹配的无关供者相比，使用HLA有限错配的供者与白血病复发率降低相关（RR：0.5，CI：0.3 - 0.9），但无白血病生存率无改善。骨髓细胞移植剂量高于中位数3.65 × 10（8）/kg与更快的中性粒细胞（RR：1.5，CI：1.1 - 2.0）和血小板（RR：4.5，CI：2.7 - 7.5）植入有关，严重急性移植物抗宿主病的发生率降低（RR：0.6，CI：0.4 - 0.9）。在缓解期移植的患者中，使用高于中位数的骨髓细胞剂量可减少非白血病死亡（RR：0.2，CI：0.1 - 0.4）和改善无白血病生存率（治疗失败的RR：0.3，CI：0.2 - 0.6）。在儿童和成人中，缓解期移植高剂量骨髓细胞与最佳结局相关。(C)1997年，美国血液学会。
Transplantation of hematopoietic stem cells from an HLA-compatible unrelated volunteer is an option for patients with acute leukemia lacking a family match. However, criteria for patient and donor selection and the most effective transplant procedures, including the number of hematopoietic cells, remain to be defined. We tested factors influencing outcome of 174 patients with primary acute leukemia receiving non-T-cell depleted marrow from unrelated donors. Median patient age was 20 years (range, 0.5 to 54 years). A multivariable analysis found that leukemia in remission at the time of transplantation was associated with improved leukemia-free survival (relative risk [RR] of treatment failure: 0.5, confidence interval [CI]: 0.3 to 0.7), and presence of blasts in the peripheral blood, as opposed to marrow involvement only or isolated extramedullary relapse, was associated with impaired outcome (RR of treatment failure: 2.5, CI: 1.7 to 5.0). The use of donors with a limited HLA-mismatch was associated with decreased leukemic relapse (RR: 0.5, CI: 0.3 to 0.9) but no improvement in leukemia-free survival compared with HLA-matched unrelated donors. Transplantation of a marrow cell dose above the median value of 3.65 x 10(8)/kg was associated with faster neutrophil (RR: 1.5, CI: 1.1 to 2.0) and platelet (RR: 4.5, CI: 2.7 to 7.5) engraftment, and decreased incidence of severe acute graft-versus-host disease (RR: 0.6, CI: 0.4 to 0.9). In patients transplanted in remission, the use of a marrow cell dose above the median translated into less nonleukemic death (RR: 0.2, CI: 0.1 to 0.4) and better leukemia-free survival (RR of treatment failure: 0.3, CI: 0.2 to 0.6). Transplant in remission with a high dose of marrow cells was associated with the best outcome in both children and adults. (C) 1997 by The American Society of Hematology.