Feasibility of TBI-Augmented Reduced Toxicity Conditioning Regimen with ATG/PTCy Combination for Haploidentical Donor Transplantation in Adult Acute Lymphoblastic Leukemia.

IF 3.6 3区 医学 Q2 HEMATOLOGY
Jaehyun Ahn, Daehun Kwag, Gi June Min, Sung-Soo Park, Silvia Park, Sung-Eun Lee, Byung-Sik Cho, Ki-Seong Eom, Yoo-Jin Kim, Hee-Je Kim, Chang-Ki Min, Seok-Goo Cho, Jae-Ho Yoon
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引用次数: 0

Abstract

Background: Haploidentical donor transplantation (HIDT) with post-transplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis is a promising alternative donor option for adults with high-risk acute lymphoblastic leukemia (ALL). However, the optimal conditioning regimen and GVHD prophylaxis strategy in this patient population remain unclear.

Methods: We evaluated a newly optimized reduced-toxicity conditioning (RTC) regimen which consisted of fludarabine 150 mg/m2, melphalan 100 mg/m2, and low-dose total body irradiation 400 cGy (FMTBI) with GVHD prophylaxis using ATG/PTCy combination in 26 adult patients with ALL undergoing HIDT. We compared the new regimen to 52 historical controls receiving fludarabine 150 mg/m2 plus busulfan 9.6 mg/kg (FB) with ATG. Key endpoints included disease-free survival (DFS), overall survival (OS), GVHD-and-relapse-free survival (GRFS), relapse, non-relapse mortality (NRM), and post-transplantation immune reconstitution.

Results: At one year, the FMTBI group had higher DFS (80.4% vs. 51.9%, p=0.024) and a trend toward improved GRFS (61.0% vs. 34.6%, p=0.073). Relapse incidence was slightly lower (11.9% vs. 32.7%, p=0.059), particularly in the CNS. The cumulative incidence of moderate to severe chronic GVHD was lower (0.0% vs. 11.5%, p=0.074) in the FMTBI group. OS (82.9% vs. 78.8%, p=0.465) and NRM (7.7% vs. 15.4%, p=0.342) rates were similar. NK/NKT cell recovery was transiently delayed at 3 months after FMTBI regimen but normalized by 6 months.

Conclusions: Our newly optimized FMTBI with ATG/PTCy combination showed improved DFS and relapse control while reducing chronic GVHD compared to historical FB with ATG alone in HIDT for adult ALL.

ATG/PTCy联合tbi增强减毒方案用于成人急性淋巴细胞白血病单倍体供体移植的可行性
背景:单倍体供体移植(HIDT)与移植后环磷酰胺(PTCy)为基础的移植物抗宿主病(GVHD)预防是一个有希望的替代供体选择成人高风险急性淋巴细胞白血病(ALL)。然而,该患者群体的最佳调理方案和GVHD预防策略仍不清楚。方法:我们评估了一种新优化的降低毒性调节(RTC)方案,该方案由氟达拉滨150 mg/m2,美法兰100 mg/m2,低剂量全身照射400 cGy (FMTBI)联合ATG/PTCy预防26例接受HIDT的成年ALL患者的GVHD。我们将新方案与52名接受氟达拉滨150 mg/m2 +布硫凡9.6 mg/kg (FB)和ATG治疗的历史对照组进行比较。主要终点包括无病生存期(DFS)、总生存期(OS)、gvhd和无复发生存期(GRFS)、复发、非复发死亡率(NRM)和移植后免疫重建。结果:1年时,FMTBI组DFS较高(80.4% vs. 51.9%, p=0.024), GRFS有改善趋势(61.0% vs. 34.6%, p=0.073)。复发率略低(11.9% vs. 32.7%, p=0.059),特别是在中枢神经系统。FMTBI组中至重度慢性GVHD的累积发病率较低(0.0%比11.5%,p=0.074)。OS (82.9% vs. 78.8%, p=0.465)和NRM (7.7% vs. 15.4%, p=0.342)相似。FMTBI治疗后3个月NK/NKT细胞恢复短暂延迟,但6个月恢复正常。结论:我们新优化的FMTBI与ATG/PTCy联合在成人ALL的HIDT中,与单独使用ATG相比,可以改善DFS和复发控制,同时减少慢性GVHD。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
15.60%
发文量
1061
审稿时长
51 days
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