Haploidentical transplant with posttransplant cyclophosphamide vs matched unrelated donor transplant for acute myeloid leukemia

被引：528

作者：

Ciurea, Stefan O. ^{[1
]}

Zhang, Mei-Jie ^{[2
,3
]}

Bacigalupo, Andrea A. ^{[4
]}

Bashey, Asad ^{[5
]}

Appelbaum, Frederick R. ^{[6
]}

Aljitawi, Omar S. ^{[7
]}

Armand, Philippe ^{[8
]}

Antin, Joseph H. ^{[8
]}

Chen, Junfang ^{[2
]}

Devine, Steven M. ^{[9
]}

Fowler, Daniel H. ^{[10
]}

Luznik, Leo ^{[11
]}

Nakamura, Ryotaro ^{[12
]}

O'Donnell, Paul V. ^{[6
]}

Perales, Miguel-Angel ^{[13
]}

Pingali, Sai Ravi ^{[1
]}

Porter, David L. ^{[14
]}

Riches, Marcie R. ^{[15
]}

Ringden, Olle T. H. ^{[16
]}

Rocha, Vanderson ^{[17
]}

Vij, Ravi ^{[18
]}

Weisdorf, Daniel J. ^{[19
]}

Champlin, Richard E. ^{[1
]}

Horowitz, Mary M. ^{[2
]}

Fuchs, Ephraim J. ^{[11
]}

Eapen, Mary ^{[2
]}

机构：

[1] Univ Texas MD Anderson Canc Ctr, Dept Med, Houston, TX 77030 USA

[2] Med Coll Wisconsin, Dept Med, Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA

[3] Med Coll Wisconsin, Inst Hlth & Soc, Div Biostat, Milwaukee, WI 53226 USA

[4] IRCCS Azienda Osped Univ AOU San Martino IST, Dept Hematol, Genoa, Italy

[5] Northside Hosp, Dept Med, Atlanta, GA USA

[6] Fred Hutchinson Canc Res Ctr, Div Clin Res, Seattle, WA 98104 USA

[7] Univ Kansas, Med Ctr, Dept Med, Kansas City, KS 66103 USA

[8] Dana Farber Canc Inst, Dept Med Oncol, Boston, MA 02115 USA

[9] Ohio State Univ, Dept Internal Med, Arthur C James Canc Hosp, Ctr Comprehens Canc, Columbus, OH 43210 USA

[10] NCI, Expt Transplantat & Immunobiol, Expt Transplantat & Immunol Branch, Bethesda, MD 20892 USA

[11] Johns Hopkins Univ, Sidney Kimmel Canc Ctr, Dept Med Hematol, Baltimore, MD USA

[12] City Hope Natl Med Ctr, Dept Hematol & Hematopoiet Cell Transplantat, Duarte, CA 91010 USA

[13] Mem Sloan Kettering Canc Ctr, Dept Med, Adult Bone Marrow Transplantat Serv, New York, NY 10021 USA

[14] Univ Penn, Abramson Canc Ctr, Hematol Oncol, Philadelphia, PA 19104 USA

[15] H Lee Moffitt Canc Ctr & Res Inst, Dept Med, Tampa, FL USA

[16] Karolinska Inst, Dept Lab Med, Div Therapeut Immunol, Stockholm, Sweden

[17] Churchill Hosp, Oxford OX3 7LJ, England

[18] Washington Univ, Sch Med, Div Hematol & Oncol, St Louis, MO USA

[19] Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA

来源：

BLOOD | 2015年 / 126卷 / 08期

基金：

美国国家卫生研究院;

关键词：

HEMATOPOIETIC-CELL TRANSPLANTATION; HLA-MISMATCHED/HAPLOIDENTICAL BLOOD; BONE-MARROW-TRANSPLANTATION; HIGH-RISK; HEMATOLOGIC MALIGNANCIES; INTERNATIONAL BLOOD; COMPLETE REMISSION; GRAFT FAILURE; STEM-CELLS; OUTCOMES;

D O I：

10.1182/blood-2015-04-639831

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

We studied adults with acute myeloid leukemia (AML) after haploidentical (n = 192) and 8/8 HLA-matched unrelated donor (n = 1982) transplantation. Haploidentical recipients received calcineurin inhibitor (CNI), mycophenolate, and posttransplant cyclophosphamide for graft-versus-host disease (GVHD) prophylaxis; 104 patients received myeloablative and 88 received reduced intensity conditioning regimens. Matched unrelated donor transplant recipients received CNI with mycophenolate or methotrexate for GVHD prophylaxis; 1245 patients received myeloablative and 737 received reduced intensity conditioning regimens. In the myeloablative setting, day 30 neutrophil recovery was lower after haploidentical compared with matched unrelated donor transplants (90% vs 97%, P = .02). Corresponding rates after reduced intensity conditioning transplants were 93% and 96% (P = .25). In the myeloablative setting, 3-month acute grade 2-4 (16% vs 33%, P < .0001) and 3-year chronic GVHD (30% vs 53%, P < .0001) were lower after haploidentical compared with matched unrelated donor transplants. Similar differences were observed after reduced intensity conditioning transplants, 19% vs 28% (P = .05) and 34% vs 52% (P = .002). Among patients receiving myeloablative regimens, 3-year probabilities of overall survival were 45% (95% CI, 36-54) and 50% (95% CI, 47-53) after haploidentical and matched unrelated donor transplants (P5.38). Corresponding rates after reduced intensity conditioning transplants were 46%(95% CI, 35-56) and 44% (95% CI, 0.40-47) (P = .71). Although statistical poweris limited, these data suggests that survival for patients with AML after haploidentical transplantation with posttransplant cyclophosphamide is comparable with matched unrelated donor transplantation.

引用

页码：1033 / 1040

页数：8

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