来自欧洲血液和骨髓移植学会急性白血病工作组的一项研究：在第二次完全缓解的AML患者中，PTCy单倍体移植比匹配的无亲属供体移植具有更高的无GVHD、无复发生存率

IF 10.1 1区医学 Q1 HEMATOLOGY

American Journal of Hematology Pub Date : 2025-07-12 DOI:10.1002/ajh.70008

Yishan Ye, Myriam Labopin, Ibrahim Yakoub‐Agha, Gérard Socié, Didier Blaise, Tobias Gedde‐Dahl, Igor Wolfgang Blau, Anna Maria Raiola, Jennifer Byrne, Etienne Daguindau, Hélène Labussière‐Wallet, Anne Huynh, Ali Bazarbachi, Arnon Nagler, Eolia Brissot, Lin Li, Yi Luo, Jimin Shi, Mohamad Mohty, He Huang, Fabio Ciceri

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引用次数: 0

摘要

急性髓系白血病（AML）患者在第二次完全缓解（CR2）时移植的供体偏好尚不清楚，来自单倍体相同供体（HAPLO）的移植后环磷酰胺（PTCy）造血细胞移植（HCT）值得关注。研究人员分析了2010年至2022年欧洲血液和骨髓移植协会登记的3878名成年AML患者在CR2中首次接受同种异体HCT的数据。采用单因素分析和Cox回归模型。分析了803例HAPLO PTCy、1271例配对兄弟姐妹供体（MSD）和1804例配对非亲属供体（MUD）的hct结果。欧洲白血病（ELN2022）中/不良风险细胞遗传学患者中，HAPLO PTCy患者接受同种异体HCT的比例（80.7%）高于MUD（79.6%）或MSD（70.2%）。在多变量分析中，HAPLO PTCy移植物(风险比[HR] = 0.65, 95%可信区间[CI] 0.51-0.82；p & lt;0.001)与MSD hct相比，复发率（RI）较低，尽管非复发死亡率更高(HR = 1.77, 95% CI 1.34-2.34；p & lt;0.001)。与MSD移植相比，HAPLO PTCy移植在无白血病生存、无移植物抗宿主病（GVHD）、无复发生存（GRFS）方面没有观察到差异。值得注意的是，HAPLO PTCy HCT与较低的RI相关(HR = 0.64, 95% CI 0.48-0.82；p & lt;0.001)，慢性GVHD (cGVHD) (HR = 0.64, 95% CI 0.51-0.81；p & lt;0.001)和广泛的cGVHD (HR = 0.47, 95% CI 0.34-0.66；p & lt;0.001)的发病率与MUD hct相比。总的来说，HAPLO PTCy HCT与较好的GRFS相关(HR = 0.81, 95% CI 0.68-0.95；p = 0.013)优于MUD HCT。对于CR2的AML患者，HAPLO PTCy HCT与较低的RI和cGVHD相关，与MUD HCT相比，导致更高的GRFS。

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Superior GVHD‐Free, Relapse‐Free Survival for Haploidentical Transplant With PTCy Than Matched Unrelated Donor for AML Patients Transplanted in Second Complete Remission: A Study From the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation

Donor preference for acute myeloid leukemia (AML) patients transplanted in second complete remission (CR2) remains unclear, and hematopoietic cell transplantation (HCT) with post‐transplant cyclophosphamide (PTCy) from a haploidentical donor (HAPLO) merits attention. Data of 3878 adult AML patients receiving a first allo‐HCT in CR2 from the European Society of Blood and Marrow Transplantation registry between 2010 and 2022 were analyzed. Univariate analyses and Cox regression models were used. Results of HCTs from 803 HAPLO PTCy, 1271 matched sibling donor (MSD), and 1804 matched unrelated donor (MUD) were analyzed. A higher proportion (80.7%) of patients with European LeukemiaNet (ELN2022) intermediate−/adverse‐risk cytogenetics received an allo‐HCT from HAPLO PTCy than from either MUD (79.6%) or MSD (70.2%). On multivariate analysis, HAPLO PTCy grafts (hazard ratio [HR] = 0.65, 95% confidence interval [CI] 0.51–0.82; p < 0.001) were associated with a lower relapse incidence (RI) compared with MSD HCTs, although non‐relapse mortality was higher (HR = 1.77, 95% CI 1.34–2.34; p < 0.001). No difference was observed with respect to leukemia‐free survival and graft‐versus‐host disease (GVHD)‐free, relapse‐free survival (GRFS) for HAPLO PTCy compared to MSD grafts. Notably, HAPLO PTCy HCT was associated with significantly lower RI (HR = 0.64, 95% CI 0.48–0.82; p < 0.001), chronic GVHD (cGVHD) (HR = 0.64, 95% CI 0.51–0.81; p < 0.001) and extensive cGVHD (HR = 0.47, 95% CI 0.34–0.66; p < 0.001) incidences compared to MUD HCTs. Collectively, HAPLO PTCy HCT was associated with superior GRFS (HR = 0.81, 95% CI 0.68–0.95; p = 0.013) than MUD HCT. For AML patients in CR2, HAPLO PTCy HCT is associated with lower RI and cGVHD, leading to superior GRFS compared with MUD HCTs.

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来源期刊

American Journal of Hematology 医学-血液学

CiteScore

15.70

自引率

3.90%

发文量

363

审稿时长

3-6 weeks

期刊介绍： The American Journal of Hematology offers extensive coverage of experimental and clinical aspects of blood diseases in humans and animal models. The journal publishes original contributions in both non-malignant and malignant hematological diseases, encompassing clinical and basic studies in areas such as hemostasis, thrombosis, immunology, blood banking, and stem cell biology. Clinical translational reports highlighting innovative therapeutic approaches for the diagnosis and treatment of hematological diseases are actively encouraged.The American Journal of Hematology features regular original laboratory and clinical research articles, brief research reports, critical reviews, images in hematology, as well as letters and correspondence.