The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation
The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation
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DOI：
10.1182/blood-2008-07-163212
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发表时间：
2009-03-26
期刊：
影响因子：
20.3
通讯作者：
Arora, Mukta
中科院分区：
文献类型：
--
作者：
Ringden, Olle;Pavletic, Steven Z.;Arora, Mukta
一些患者从非亲属供体（URD）移植中获益是因为移植物抗白血病（GVL）效果更强吗？我们分析了1995年至2004年间向CIBMTR报告的4099例急性髓性白血病（AML）、急性淋巴细胞白血病（ALL）和慢性髓性白血病（CML）接受清髓性异基因造血细胞移植（HCT）的患者，这些患者来自URD（8/8人白细胞抗原[HLA]匹配，n = 941）或HLA相同的兄弟姐妹供体（n = 3158）。在Cox回归模型中，加入急性和慢性GVHD作为时间相关变量。在多因素分析中，URD移植受者在AML患者中有更高的移植相关死亡率（TRM；相对风险[RR]， 2.76; P < 0.001）和复发风险（RR, 1.50; P < 0.001），但在ALL或CML患者中没有。在所有诊断中，慢性GVHD与较低的复发风险相关。无急性GVHD的AML患者接受URD移植的无白血病生存期（LFS）降低（RR, 2.02; P < .001），但与ALL和CML患者接受相同hla的同胞移植的无白血病生存期相当。在没有GVHD的患者中，多变量分析显示，在所有3种诊断中，URD移植的复发风险相似，但LFS降低。总之，与hla相同的同胞移植受者相比，URD移植受者的复发风险相同（ALL， CML）或更严重（AML），表明GVL效应相似。（血液杂志，2009;113:3110-3118）
Do some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]matched, n = 941) or HLA-identical sibling donor (n = 3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P < .001) and relapse (RR, 1.50; P < .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P < .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect. (Blood. 2009; 113: 3110-3118)