Anna Maria Raiola , Emanuele Angelucci , Simona Sica , Andrea Bacigalupo
{"title":"单倍体骨髓移植+ 3 + 5天移植后使用环磷酰胺:热那亚方案","authors":"Anna Maria Raiola , Emanuele Angelucci , Simona Sica , Andrea Bacigalupo","doi":"10.1016/j.blre.2022.101031","DOIUrl":null,"url":null,"abstract":"<div><p><span><span>We report 634 patients who underwent unmanipulated haploidentical (HAPLO) bone marrow transplantation (BMT) in two Centers. The diagnosis was </span>acute myeloid leukemia (AML) (</span><em>n</em><span> = 251), acute lymphoblastic leukemia (ALL)(</span><em>n</em><span> = 107), myelodysplastic syndrome and myelofibrosis (MDS + MF) (</span><em>n</em><span> = 125) and chronic lymphoproliferative disorders (</span><em>n</em><span><span> = 151). Median age was 52 years (16–74). Graft versus host disease (GvHD) prophylaxis was intravenous </span>cyclosporin<span><span><span> (CSA) starting on day 0, oral mycophenolate on day +1, and post-transplant </span>cyclophosphamide<span><span><span> (PTCY) on days +3 + 5. Primary graft failure was seen in 23 patients (3,6%); 17 /23 (74%) were rescued with second HAPLO graft, and were alive at one year. The cumulative incidence of </span>acute GvHD grade II-IV was 29% and 3% for grade III-IV; the cumulative incidence of moderate severe </span>chronic GvHD was 23%: older donor and patients age were significant predictors of both acute and chronic GvHD. The overall non relapse mortality (NRM) at 2 years was 19%: 8%, 21% and 30% </span></span>in patients<span><span> aged <40, 41–60 > 60 years. Disease free survival (DFS) at 5 years was 64% for </span>acute leukemia in first remission, 51% for acute leukemia CR2, 25% for acute leukemia advanced disease and 49% for MDS/MPN.</span></span></span></p><p>We confirm, on a relatively large number of patients, that unmanipulated HAPLO BMT with PTCY on days +3 + 5, mostly after a myeloablative conditioning regimen, is followed by a low incidence of graft failure and grade III-IV GvHD; moderate severe chronic GvHD is 23% and NRM at 2 years 19%; 5 year DFS is influenced by remission status of the underlying disease.</p></div>","PeriodicalId":56139,"journal":{"name":"Blood Reviews","volume":null,"pages":null},"PeriodicalIF":6.9000,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":"{\"title\":\"Haploidentical bone marrow transplants with post transplant cyclophosphamide on day + 3 + 5: The Genova protocol\",\"authors\":\"Anna Maria Raiola , Emanuele Angelucci , Simona Sica , Andrea Bacigalupo\",\"doi\":\"10.1016/j.blre.2022.101031\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><p><span><span>We report 634 patients who underwent unmanipulated haploidentical (HAPLO) bone marrow transplantation (BMT) in two Centers. The diagnosis was </span>acute myeloid leukemia (AML) (</span><em>n</em><span> = 251), acute lymphoblastic leukemia (ALL)(</span><em>n</em><span> = 107), myelodysplastic syndrome and myelofibrosis (MDS + MF) (</span><em>n</em><span> = 125) and chronic lymphoproliferative disorders (</span><em>n</em><span><span> = 151). Median age was 52 years (16–74). Graft versus host disease (GvHD) prophylaxis was intravenous </span>cyclosporin<span><span><span> (CSA) starting on day 0, oral mycophenolate on day +1, and post-transplant </span>cyclophosphamide<span><span><span> (PTCY) on days +3 + 5. Primary graft failure was seen in 23 patients (3,6%); 17 /23 (74%) were rescued with second HAPLO graft, and were alive at one year. The cumulative incidence of </span>acute GvHD grade II-IV was 29% and 3% for grade III-IV; the cumulative incidence of moderate severe </span>chronic GvHD was 23%: older donor and patients age were significant predictors of both acute and chronic GvHD. The overall non relapse mortality (NRM) at 2 years was 19%: 8%, 21% and 30% </span></span>in patients<span><span> aged <40, 41–60 > 60 years. Disease free survival (DFS) at 5 years was 64% for </span>acute leukemia in first remission, 51% for acute leukemia CR2, 25% for acute leukemia advanced disease and 49% for MDS/MPN.</span></span></span></p><p>We confirm, on a relatively large number of patients, that unmanipulated HAPLO BMT with PTCY on days +3 + 5, mostly after a myeloablative conditioning regimen, is followed by a low incidence of graft failure and grade III-IV GvHD; moderate severe chronic GvHD is 23% and NRM at 2 years 19%; 5 year DFS is influenced by remission status of the underlying disease.</p></div>\",\"PeriodicalId\":56139,\"journal\":{\"name\":\"Blood Reviews\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":6.9000,\"publicationDate\":\"2023-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Blood Reviews\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0268960X22001059\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Blood Reviews","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0268960X22001059","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Haploidentical bone marrow transplants with post transplant cyclophosphamide on day + 3 + 5: The Genova protocol
We report 634 patients who underwent unmanipulated haploidentical (HAPLO) bone marrow transplantation (BMT) in two Centers. The diagnosis was acute myeloid leukemia (AML) (n = 251), acute lymphoblastic leukemia (ALL)(n = 107), myelodysplastic syndrome and myelofibrosis (MDS + MF) (n = 125) and chronic lymphoproliferative disorders (n = 151). Median age was 52 years (16–74). Graft versus host disease (GvHD) prophylaxis was intravenous cyclosporin (CSA) starting on day 0, oral mycophenolate on day +1, and post-transplant cyclophosphamide (PTCY) on days +3 + 5. Primary graft failure was seen in 23 patients (3,6%); 17 /23 (74%) were rescued with second HAPLO graft, and were alive at one year. The cumulative incidence of acute GvHD grade II-IV was 29% and 3% for grade III-IV; the cumulative incidence of moderate severe chronic GvHD was 23%: older donor and patients age were significant predictors of both acute and chronic GvHD. The overall non relapse mortality (NRM) at 2 years was 19%: 8%, 21% and 30% in patients aged <40, 41–60 > 60 years. Disease free survival (DFS) at 5 years was 64% for acute leukemia in first remission, 51% for acute leukemia CR2, 25% for acute leukemia advanced disease and 49% for MDS/MPN.
We confirm, on a relatively large number of patients, that unmanipulated HAPLO BMT with PTCY on days +3 + 5, mostly after a myeloablative conditioning regimen, is followed by a low incidence of graft failure and grade III-IV GvHD; moderate severe chronic GvHD is 23% and NRM at 2 years 19%; 5 year DFS is influenced by remission status of the underlying disease.
期刊介绍:
Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.