单倍体骨髓移植+ 3 + 5天移植后使用环磷酰胺:热那亚方案

IF 6.9 2区 医学 Q1 HEMATOLOGY
Anna Maria Raiola , Emanuele Angelucci , Simona Sica , Andrea Bacigalupo
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引用次数: 1

摘要

我们报告了634例在两个中心接受未经处理的单倍同(HAPLO)骨髓移植(BMT)的患者。诊断为急性髓性白血病(AML) (n = 251)、急性淋巴细胞白血病(ALL)(n = 107)、骨髓增生异常综合征及骨髓纤维化(MDS + MF) (n = 125)和慢性淋巴细胞增生性疾病(n = 151)。中位年龄为52岁(16-74岁)。预防移植物抗宿主病(GvHD)的方法是第0天开始静脉注射环孢素(CSA),第1天口服霉酚酸酯,第3天+第5天移植后使用环磷酰胺(PTCY)。23例(3.6%)患者出现原发性移植物衰竭;17 /23例(74%)在第二次HAPLO移植后获救,1年后存活。急性GvHD II-IV级累积发病率为29%,III-IV级为3%;中重度慢性GvHD的累积发病率为23%:年龄较大的供体和患者年龄是急性和慢性GvHD的重要预测因素。2年总非复发死亡率(NRM)分别为19%、8%、21%和30%,年龄分别为40岁、41岁和60岁。60年。5年无病生存率(DFS)急性白血病首次缓解期为64%,急性白血病CR2期为51%,急性白血病晚期为25%,MDS/MPN期为49%。我们证实,在相对较多的患者中,未经操作的HAPLO BMT + PTCY在+3 + 5天,大多数在清髓调节方案后,移植物失败和III-IV级GvHD的发生率较低;中重度慢性GvHD为23%,2年NRM为19%;5年DFS受基础疾病缓解状态的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
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.
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