Nonmyeloablative, HLA-haploidentical bone marrow transplantation with high dose, post-transplantation cyclophosphamide.
Nonmyeloablative, HLA-haploidentical bone marrow transplantation with high dose, post-transplantation cyclophosphamide.
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DOI：
10.4081/pr.2011.s2.e15
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发表时间：
2011-06-22
影响因子：
1.1
通讯作者：
Fuchs EJ
中科院分区：
文献类型：
--
作者：
Munchel A;Kesserwan C;Symons HJ;Luznik L;Kasamon YL;Jones RJ;Fuchs EJ
来自HLA半相合亲属的异基因干细胞移植（SCT）为缺乏合适HLA匹配供体的恶性血液病患者提供了一种潜在的治愈性治疗选择。进行HLA半相合SCT的最大挑战是移植失败和严重移植物抗宿主病（GVHD）的高发生率。我们的研究小组一直在探索高剂量的环磷酰胺（Cy），作为预防非清髓性，HLA半相合骨髓移植后的GVHD，或mini-haploBMT。在210例接受mini-haploBMT的患者中，87%的患者经历了持续的供体细胞植入。II-IV级急性GVHD和慢性GVHD的累积发生率分别为27%和13%。5年累积非复发死亡率为18%，复发率为55%，精算总生存率和无事件生存率分别为35%和27%。这些结果表明，移植后Cy的迷你haploBMT与可接受的低毒性相关，并且可以为许多晚期恶性血液病患者提供长期生存，如果不能治愈的话。
Allogeneic stem cell transplantation (SCT) from an HLA-haploidentical relative provides a potentially curative treatment option for hematologic malignancies patients who lack a suitably HLA-matched donor. The greatest challenge to performing HLA-haploidentical SCT has been high rates of graft failure and severe graft-versus-host disease (GVHD). Our group has been exploring high dose, post-transplantation cyclophosphamide (Cy) as prophylaxis of GVHD after nonmyeloablative, HLA-haploidentical bone marrow transplantation, or mini-haploBMT. Among 210 recipients of mini-haploBMT, 87% of patients have experienced sustained donor cell engraftment. The cumulative incidences of grades II-IV acute GVHD and chronic GVHD are 27% and 13%, respectively. Five-year cumulative incidence of non-relapse mortality is 18%, relapse is 55%, and actuarial overall survival and event-free survivals are 35% and 27%, respectively. These outcomes suggest that mini-haploBMT with post-transplantation Cy is associated with acceptably low toxicities and can provide longterm survival, if not cure, for many patients with advanced hematologic malignancies.