Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1-Associated Adult T Cell Lymphoma-Leukemia in the United States: Experience from a Large Cohort in a Major Tertiary Center.
Barriers to Allogeneic Hematopoietic Stem Cell Transplantation for Human T Cell Lymphotropic Virus 1-Associated Adult T Cell Lymphoma-Leukemia in the United States: Experience from a Large Cohort in a Major Tertiary Center.
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DOI：
10.1016/j.bbmt.2019.02.004
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发表时间：
2019-06
期刊：
影响因子：
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通讯作者：
Janakiram M
中科院分区：
文献类型：
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作者：
Adrianzen Herrera D;Kornblum N;Acuna-Villaorduna A;Sica RA;Shah U;Butler M;Vishnuvardhan N;Shah N;Bachier-Rodriguez L;Derman O;Shastri A;Mantzaris I;Verma AK;Braunschweig I;Janakiram M
在美国，成人 T 细胞淋巴瘤 - 白血病 (ATLL) 的预后很差，主要影响来自人类 T 细胞嗜淋巴细胞病毒 1 流行区的移民。同种异体造血干细胞移植 (alloHSCT) 可能有效，并被国家综合癌症网络指南推荐作为前期治疗。我们在美国最大的 ATLL 人群之一中研究了异基因造血干细胞移植 (alloHSCT) 的障碍。对 2003 年至 2018 年在 Montefiore 医疗中心治疗的 88 名 ATLL 患者进行了全面的图表和供体登记审查。在 49 名急性患者和 32 名淋巴瘤亚型患者中，48 名患者 (59.5%) 不适合接受 alloHSCT，因为早期死亡 (52%)、失访 (21%)、无保险状态 (15%)、患者拒绝 (10%) 和虚弱（2%）。在 28 名 HLA 分型合格患者 (34.6%) 中，确定了 7 名 (25%) 匹配的相关捐献者。匹配无关供者 (MUD) 搜索结果显示 2 名患者 (9.5%) 的 HLA 匹配，6 名患者 (28.5%) 的 HLA 不匹配，13 名患者 (62%) 没有选择。确定了 6 名患者 (46%) 的单倍体捐献者，没有不相关的选择。 7 名（25%）符合异基因造血干细胞移植资格的患者没有合适的供体。捐献者鉴定后异基因造血干细胞移植的主要限制是因疾病进展而死亡（82%）。 10 名患者 (12.3%) 进行了 AlloHSCT，其与更好的无复发生存期（26 个月与 11 个月，P = .04）和总生存期（47 个月与 10 个月，P = .03）相关。早期死亡和疾病进展是异基因造血干细胞移植的主要障碍，但随访不良、未投保状态以及缺乏合适的供体（包括半相合供体）也是可能对这一弱势群体产生不成比例影响的重大限制。 AlloHSCT 可以实现长期缓解，迫切需要旨在克服这些障碍的策略来改善 ATLL 的预后。
In the United States adult T cell lymphoma–leukemia (ATLL) carries a dismal prognosis and mainly affects immigrants from human T cell lymphotropic virus 1 endemic areas. Allogeneic hematopoietic stem cell transplant (alloHSCT) can be effective and is recommended as an upfront treatment in the National Comprehensive Cancer Network guidelines. We studied the barriers to alloHSCT in 1 of the largest ATLL populations in the United States. Comprehensive chart and donor registry reviews were conducted for 88 ATLL patients treated at Montefiore Medical Center from 2003 to 2018. Among 49 patients with acute and 32 with lymphomatous subtypes, 48 (59.5%) were ineligible for alloHSCT because of early mortality (52%), loss to follow-up (21%), uninsured status (15%), patient declination (10%), and frailty (2%). Among 28 HLA-typed eligible patients (34.6%) matched related donors were identified for 7 (25%). A matched unrelated donor (MUD) search yielded HLA-matched in 2 patients (9.5%), HLA mismatched in 6 (28.5%), and no options in 13 (62%). Haploidentical donors were identified for 6 patients (46%) with no unrelated options. There were no suitable donors for 7 (25%) alloHSCT-eligible patients. The main limitation for alloHSCT after donor identification was death from progressive disease (82%). AlloHSCT was performed in 10 patients (12.3%) and was associated with better relapse-free survival (26 versus 11 months, P = .04) and overall survival (47 versus 10 months, P = .03). Early mortality and progressive disease are the main barriers to alloHSCT, but poor follow-up, uninsured status, and lack of suitable donor, including haploidentical, are also substantial limitations that might disproportionally affect this vulnerable population. AlloHSCT can achieve long-term remissions, and strategies aiming to overcome these barriers are urgently needed to improve outcomes in ATLL.