Reduced intensity haplo plus single cord transplant compared to double cord transplant: improved engraftment and graft-versus-host disease-free, relapse-free survival

被引：34

作者：

van Besien, Koen ^{[1
,2
]}

Hari, Parameswaran ^{[3
]}

Zhang, Mei-Jie ^{[3
]}

Liu, Hong-Tao ^{[4
]}

Stock, Wendy ^{[4
]}

Godley, Lucy ^{[4
]}

Odenike, Olatoyosi ^{[4
]}

Larson, Richard ^{[4
]}

Bishop, Michael ^{[4
]}

Wickrema, Amittha ^{[4
]}

Gergis, Usama ^{[1
,2
]}

Mayer, Sebastian ^{[1
,2
]}

Shore, Tsiporah ^{[1
,2
]}

Tsai, Stephanie ^{[1
,2
]}

Rhodes, Joanna ^{[1
,2
]}

Cushing, Melissa M. ^{[5
]}

Korman, Sandra ^{[3
]}

Artz, Andrew ^{[1
,2
]}

机构：

[1] Weill Cornell Med Coll, Dept Hematol Oncol, New York, NY 10065 USA

[2] Weill Cornell Med Coll, Stem Cell Transplant Program, Meyer Canc Ctr, New York, NY 10065 USA

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

[4] Univ Chicago, Sect Hematol Oncol, Hematopoiet Cellular Therapy Program, Chicago, IL 60637 USA

[5] Weill Cornell Med Coll, Cellular Therapy Lab, Dept Pathol, New York, NY USA

来源：

HAEMATOLOGICA | 2016年 / 101卷 / 05期

关键词：

HEMATOPOIETIC-CELL TRANSPLANTATION; ALTERNATIVE DONOR TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; BLOOD TRANSPLANTATION; ANTITHYMOCYTE GLOBULIN; UNRELATED DONOR; BONE-MARROW; MYELODYSPLASTIC SYNDROME; 3RD-PARTY DONOR; OLDER PATIENTS;

D O I：

10.3324/haematol.2015.138594

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Umbilical cord blood stem cell transplants are commonly used in adults lacking HLA-identical donors. Delays in hematopoietic recovery contribute to mortality and morbidity. To hasten recovery, we used co-infusion of progenitor cells from a partially matched related donor and from an umbilical cord blood graft (haplo-cord transplant). Here we compared the outcomes of haplo-cord and double-cord transplants. A total of 97 adults underwent reduced intensity conditioning followed by haplo-cord transplant and 193 patients received reduced intensity conditioning followed by double umbilical cord blood transplantation. Patients in the haplo-cord group were more often from minority groups and had more advanced malignancy. Haplo-cord recipients received fludarabine-melphalan-anti-thymocyte globulin. Double umbilical cord blood recipients received fludarabine-cyclophosphamide and low-dose total body irradiation. In a multivariate analysis, haplo-cord had faster neutrophil (HR=1.42, P=0.007) and platelet (HR=2.54, P<0.0001) recovery, lower risk of grade II-IV acute graft-versus-host disease (HR=0.26, P<0.0001) and chronic graft-versus-host disease (HR=0.06, P<0.0001). Haplo-cord was associated with decreased risk of relapse (HR 0.48, P=0.001). Graft-versus-host disease-free, relapse-free survival was superior with haplo-cord (HR 0.63, P=0.002) but not overall survival (HR=0.97, P=0.85). Haplo-cord transplantation using fludarabine-melphalan-thymoglobulin conditioning hastens hematopoietic recovery with a lower risk of relapse relative to double umbilical cord blood transplantation using the commonly used fludarabine-cyclophosphamide-low-dose total body irradiation conditioning. Graft-versus-host disease-free and relapse-free survival is significantly improved. Haplo-cord is a readily available graft source that improves outcomes and access to transplant for those lacking HLA-matched donors.

引用

页码：634 / 643

页数：10

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