Alternative donor transplantation for myelodysplastic syndromes: haploidentical relative and matched unrelated donors

被引：36

作者：

Grunwald, Michael R. ^{[1
]}

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

Elmariah, Hany ^{[4
]}

Johnson, Mariam H. ^{[3
]}

St Martin, Andrew ^{[3
]}

Bashey, Asad ^{[5
]}

Battiwalla, Minoo ^{[6
]}

Bredeson, Christopher N. ^{[7
,8
]}

Copelan, Edward ^{[1
]}

Cutler, Corey S. ^{[9
]}

George, Biju R. ^{[10
]}

Gupta, Vikas ^{[11
]}

Kanakry, Christopher ^{[12
]}

Mehta, Rohtesh S. ^{[13
]}

Milano, Filippo ^{[14
]}

Mussetti, Alberto ^{[15
]}

Nakamura, Ryotaro ^{[16
]}

Nishihori, Taiga ^{[4
]}

Saber, Wael ^{[3
]}

Solh, Melhem ^{[5
]}

Weisdorf, Daniel J. ^{[17
]}

Eapen, Mary ^{[3
]}

机构：

[1] Atrium Hlth, Dept Hematol Oncol & Blood Disorders, Levine Canc Inst, 1021 Morehead Med Dr,LCI Bldg 2,Suite 60100, Charlotte, NC 28204 USA

[2] Med Coll Wisconsin, Div Biostat, Inst Heath & Equ, Milwaukee, WI 53226 USA

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

[4] H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplant & Cellular Immunot, Tampa, FL USA

[5] Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA

[6] Sarah Cannon Blood & Marrow Transplant Ctr, Centennial Med Ctr, Div Hematol Oncol, Nashville, TN USA

[7] Ottawa Hosp, Blood & Marrow Transplant Program, Ottawa, ON, Canada

[8] Ottawa Hosp, Ottawa Hosp Res Inst, Ottawa, ON, Canada

[9] Dana Farber Canc Inst, Ctr Hematol Oncol, Boston, MA 02115 USA

[10] Christian Med Coll & Hosp, Div Hematol, Vellore, Tamil Nadu, India

[11] Univ Hlth Network, Princess Margaret Canc Ctr, Blood & Marrow Transplant Program, Toronto, ON, Canada

[12] NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, NIH, Bethesda, MD 20892 USA

[13] MD Anderson Canc Ctr, Div Hematol Oncol, Houston, TX USA

[14] Fred Hutchinson Canc Res Ctr, Clin Res Div, 1124 Columbia St, Seattle, WA 98104 USA

[15] Inst Catala Oncol Hospitalet, Hematol Dept, Barcelona, Spain

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

[17] Univ Minnesota, Dept Med, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA

来源：

BLOOD ADVANCES | 2021年 / 5卷 / 04期

基金：

美国国家卫生研究院;

关键词：

HEMATOPOIETIC-CELL TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; POSTTRANSPLANTATION CYCLOPHOSPHAMIDE; BONE-MARROW; OLDER; SURVIVAL; BLOOD; CONSENSUS; OUTCOMES; GRAFTS;

D O I：

10.1182/bloodadvances.2020003654

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

We compared outcomes in 603 patients with myelodysplastic syndrome (MDS) after HLA-haploidentical relative (n = 176) and HLA-matched unrelated (n = 427) donor hematopoietic cell transplantation (HCT) from 2012 to 2017, using the Center for International Blood and Marrow Transplant Research database. All transplantations used reduced-intensity conditioning regimens. Total-body irradiation plus cyclophosphamide and fludarabine was the predominant regimen for HLA-haploidentical relative donor HCT, and graft-versus-host disease (GVHD) prophylaxis was uniformly posttransplantation cyclophosphamide, calcineurin inhibitor, and mycophenolate. Fludarabine with busulfan or melphalan was the predominant regimen for HLA-matched unrelated donor HCT, and GVHD prophylaxis was calcineurin inhibitor with mycophenolate or methotrexate. Results of multivariate analysis revealed higher relapse (hazard ratio [HR], 1.56; P = .0055; 2-year relapse rate, 48% vs 33%) and lower disease-free survival (DFS) rates after HLA-haploidentical relative donor HCT (HR, 1.29; P = .042; 2-year DFS, 29% vs 36%). However, overall survival (OS) rates did not differ between donor type (HR, 0.94; P = .65; 2-year OS, 46% for HLA-haploidentical and 44% for HLA-matched unrelated donor HCT) because of mortality associated with chronic GVHD. Acute grade 2 to 4 GVHD (HR, 0.44; P < .0001) and chronic GVHD (HR, 0.36; P < .0001) were lower after HLA-haploidentical relative donor HCT. By 2 years, probability of death resulting from chronic GVHD was lower after HLA-haploidentical relative compared with HLA-matched unrelated donor HCT (6% vs 21%), negating any potential survival advantage from better relapse control. Both donor types extend access to transplantation for patients with MDS; strategies for better relapse control are desirable for HLA-haploidentical relative donor HCT, and effective GVHD prophylaxis regimens are needed for unrelated donor HCT.

引用

页码：975 / 983

页数：9

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