Improved survival after single-unit cord blood transplantation using fludarabine and melphalan-based reduced-intensity conditioning for malignant lymphoma: impact of melphalan dose and graft-versus-host disease prophylaxis with mycophenolate mofetil

被引：3

作者：

Sakatoku, Kazuki ^{[1
]}

Kim, Sung-Won ^{[2
]}

Okamura, Hiroshi ^{[1
]}

Kanaya, Minoru ^{[3
,4
]}

Kato, Koji ^{[5
]}

Yamasaki, Satoshi ^{[6
]}

Uchida, Naoyuki ^{[7
]}

Kobayashi, Hikaru ^{[8
]}

Fukuda, Takahiro ^{[2
]}

Takayama, Nobuyuki ^{[9
]}

Ishikawa, Jun ^{[10
]}

Nakazawa, Hideyuki ^{[11
]}

Sakurai, Masatoshi ^{[12
]}

Ikeda, Takashi ^{[13
]}

Kondo, Tadakazu ^{[14
]}

Yoshioka, Satoshi ^{[15
]}

Miyamoto, Toshihiro ^{[5
]}

Kimura, Takafumi ^{[16
]}

Ichinohe, Tatsuo ^{[17
]}

Atsuta, Yoshiko ^{[18
,19
]}

Kondo, Eisei ^{[20
]}

机构：

[1] Osaka City Univ, Grad Sch Med, Hematol, Osaka, Japan

[2] Natl Canc Ctr, Dept Hematopoiet Stem Cell Transplantat, Chuo Ku, 5-1-1 Tsukiji, Tokyo 1040045, Japan

[3] Oslo Univ Hosp, Inst Canc Res, Dept Canc Immunol, Oslo, Norway

[4] Hokkaido Univ Hosp, Dept Hematol, Sapporo, Hokkaido, Japan

[5] Kyushu Univ Hosp, Hematol Oncol & Cardiovasc Med, Fukuoka, Japan

[6] Kyushu Univ Beppu Hosp, Dept Internal Med, Beppu, Oita, Japan

[7] Federat Natl Publ Serv Personnel Mutual Aid Assoc, Dept Hematol, Tokyo, Japan

[8] Nagano Red Cross Hosp, Dept Hematol, Nagano, Japan

[9] Kyorin Univ, Dept Hematol, Fac Med, Tokyo, Japan

[10] Osaka Int Canc Inst, Dept Hematol, Osaka, Japan

[11] Shinshu Univ, Dept Hematol, Sch Med, Matsumoto, Nagano, Japan

[12] Keio Univ, Dept Med, Div Hematol, Sch Med, Tokyo, Japan

[13] Shizuoka Canc Ctr, Div Hematol & Stem Cell Transplantat, Shizuoka, Japan

[14] Kyoto Univ Hosp, Dept Hematol, Kyoto, Japan

[15] Kobe City Med Ctr Gen Hosp, Dept Hematol, Kobe, Hyogo, Japan

[16] Japanese Red Cross Kinki Block Blood Ctr, Preparat Dept, Osaka, Japan

[17] Hiroshima Univ, Res Inst Radiat Biol & Med, Dept Hematol & Oncol, Hiroshima, Japan

[18] Japanese Data Ctr Hematopoiet Cell Transplantat, Nagoya, Aichi, Japan

[19] Aichi Med Univ, Dept Registry Sci Transplant & Cellular Therapy, Sch Med, Nagakute, Aichi, Japan

[20] Kawasaki Med Sch, Dept Hematol, Kurashiki, Okayama, Japan

来源：

ANNALS OF HEMATOLOGY | 2022年 / 101卷 / 12期

关键词：

Melphalan dose; Graft-versus-host disease prophylaxis; Lymphoma; Cord blood transplantation; Reduced-intensity conditioning; STEM-CELL TRANSPLANTATION; ALTERNATIVE DONOR TRANSPLANTATION; PHASE-II TRIAL; ALLOGENEIC TRANSPLANTATION; MARROW-TRANSPLANTATION; PREPARATIVE REGIMEN; HODGKIN-LYMPHOMA; BONE-MARROW; OUTCOMES; THERAPY;

D O I：

10.1007/s00277-022-04990-w

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

We evaluated 413 adult patients with lymphoma who underwent unrelated cord blood transplantation (UCBT) with fludarabine and melphalan (FM)-based reduced-intensity conditioning between 2002 and 2017 to investigate longitudinal changes in outcomes and the optimal melphalan dose and graft-versus-host disease (GVHD) prophylaxis regimen. Outcomes were compared between FM80/100 (melphalan dose: 80 or 100 mg/m(2)) and FM140 (melphalan dose: 140 mg/m(2)), as well as between calcineurin inhibitor (CNI) plus methotrexate (MTX), CNI plus mycophenolate mofetil (MMF), and CNI alone. The 3-year overall survival (OS) and non-relapse mortality (NRM) rates improved over time (OS: 27% in 2000s vs. 42% in 2010s, p < 0.001; NRM: 43% in 2000s vs. 26% in 2010s, p < 0.001). Multivariable analysis showed that in the 2000s, melphalan dose and GVHD prophylaxis regimen did not affect any outcomes. In the 2010s, FM80/100 (vs. FM140) related to better OS (hazard ratio [HR] 0.62, p = 0.01) and NRM (HR 0.52, p = 0.016). MTX + CNI and CNI alone (vs. CNI + MMF) related to worse OS (CNI + MTX, HR 2.01, p < 0.001; CNI alone, HR 2.65, p < 0.001) and relapse/progression (CNI + MTX, HR 2.40, p < 0.001; CNI alone, HR 2.13, p = 0.023). In recent years, the use of FM80/100 and CNI + MMF significantly reduced the risk of NRM and relapse/progression, respectively, and resulted in better OS after UCBT for lymphoma.

引用

页码：2743 / 2757

页数：15

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