Mixed Chimerism and Secondary Graft Failure in Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia
Mixed Chimerism and Secondary Graft Failure in Allogeneic Hematopoietic Stem Cell Transplantation for Aplastic Anemia
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DOI：
10.1016/j.bbmt.2019.10.004
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发表时间：
2020-03-01
影响因子：
4.3
通讯作者：
Mori, Takehiko
中科院分区：
文献类型：
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作者：
Kako, Shinichi;Yamazaki, Hirohito;Mori, Takehiko
混合嵌合体（MC）和/或继发性移植物衰竭（SGF）与受体或供体型嵌合体是异基因移植治疗再生障碍性贫血（AA）的主要障碍。根据日本的登记数据库，本研究纳入了年龄>15岁、在2000年至2014年期间接受首次异基因骨髓或外周血干细胞移植并实现植入的AA患者。不需要粒细胞集落刺激因子（G-CSF）或输血支持的MC（第1组），需要G-CSF和/或输血支持的MC（非SGF）（第2组），具有MC或完全免疫型嵌合体的SGF（第3组）和具有完全供体型嵌合体的SGF（第4组）分别在26、16、19和17例患者中发生。幸存者的总体中位随访时间为1727天。无MC或SGF患者（n = 340）的1年总生存率（OS）为90.4%，5年为83.5%，与第1组和第2组的OS无差异。然而，第3组（1年，52.1%; 5年，52.1%）和第4组（1年，82.4%; 5年，56.3%）的OS较差。在多变量分析中，使用氟达拉滨（Flu）和在条件反射中不照射与SGF伴MC或完全免疫型嵌合体的发展相关，而在条件反射中使用Flu与SGF伴完全供体型嵌合体相关。总之，流感的使用可能会影响SGF的发生与免疫型和供体型嵌合体。(C)2019年美国移植和细胞治疗学会。爱思唯尔公司出版
Mixed chimerism (MC) and/or secondary graft failure (SGF) with recipient- or donor-type chimerism is a major obstacle in allogeneic transplantation for aplastic anemia (AA). From a registry database in Japan, patients with AA age >15 years who underwent a first allogeneic bone marrow or peripheral blood stem cell transplantation between 2000 and 2014 and achieved engraftment were included in this study. MC that did not require either granulocyte-colony stimulating factor (G-CSF) or transfusion support (group 1), MC (not SGF) that required G-CSF and/or transfusion support (group 2), SGF with MC or complete recipient-type chimerism (group 3), and SGF with complete donor-type chimerism (group 4) developed in 26, 16, 19, and 17 patients, respectively. The overall median duration of follow-up for survivors was 1727 days. The overall survival (OS) was 90.4% at 1 year and 83.5% at 5 years in patients without MC or SGF (n = 340), which was not different from the OS in groups 1 and 2. However, inferior OS was observed in group 3 (1 year, 52.1%; 5 years, 52.1%) and group 4 (1 year, 82.4%; 5 years, 56.3%). In multivariate analyses, the use of fludarabine (Flu) and the absence of irradiation in conditioning were associated with the development of SGF with MC or complete recipient-type chimerism, and the use of Flu in conditioning was associated with SGF with complete donor-type chimerism. In conclusion, the use of Flu may affect the occurrence of SGF with both recipient-type and donor-type chimerism. (C) 2019 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.