AML/MDS患者的年轻单倍型供体与较旧的不相关供体匹配
Younger haploidentical donor versus older matched unrelated donor for patients with AML/MDS
影响因子:9.90000
分区:医学1区 Top / 血液学2区
发表日期:2023 May
作者:
Curtis Marcoux, David Marin, Jeremy Ramdial, Gheath AlAtrash, Amin M Alousi, Betul Oran, Partow Kebriaei, Uday R Popat, Katayoun Rezvani, Richard E Champlin, Elizabeth J Shpall, Rohtesh S Mehta
摘要
最佳供体选择是成功的同种异体造血细胞移植（HCT）的基础，并且供体年龄在匹配无关的供体（MUD）和单倍型供体HCT之后都会影响生存。尽管最近的研究表明，泥浆和单倍性HCT之间的结果相似，但与较旧的泥浆相比，与年轻的单倍型供体HCT相比，HCT的结果是否有所不同。因此，我们进行了回顾性分析，比较了骨髓增生综合征（MDS）和急性髓样白血病（AML）患者的结果，这些患者患有年轻（≤35岁）单倍型供体（N = 494）或年龄较大（> 35岁）泥浆（> 35岁）泥浆（n = 1005）。单倍体和泥浆组的患者分别接受移植后环磷酰胺（PTCY）和常规的移植物抗宿主 - 疾病（GVHD）预防。在多变量分析中，使用年轻单倍型供体的使用与总体生存率提高有关（危险比[HR] 0.81，95％置信区间[CI] 0.69-0.95，p = .01）和较低的II-IV级急性GVHD（HR 0.64，95％CI 0.53％CI 0.53-3-3--0.77，p <.001） 0.37，95％CI 0.25-0.53，p <.001）和慢性GVHD（HR 0.49，95％CI 0.40-0.60，p <.001）。在接受骨髓性调节的患者中，复发率相似，但接受降低强度调节的年轻单倍型组患者（HR 1.49，95％CI 1.18-1.88，p = .001）。 HCT后，年轻的单倍体组显着降低了非释放死亡率≥3个月（HR 0.59，95％CI 0.38-0.90，p = .02）。我们的数据支持使用MDS或AML患者的年轻泥浆中的年轻单倍体供体，并具有传统预防的旧泥浆。有必要对供体年龄在单倍性和泥浆中具有预防PTCY HCT的重要性的进一步研究。
Abstract
Optimal donor selection is fundamental to successful allogeneic hematopoietic cell transplantation (HCT), and donor age influences survival after both matched unrelated donor (MUD) and haploidentical donor HCT. Though recent studies have shown similar outcomes between MUD and haploidentical HCT, it is unknown if outcomes differ following HCT with younger haploidentical donors compared to HCT with older MUDs. Therefore, we performed a retrospective analysis comparing outcomes of myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) patients who underwent HCT with younger (≤35 years) haploidentical donors (n = 494) or older (>35 years) MUDs (n = 1005). Patients in the haploidentical and MUD groups received post-transplant cyclophosphamide (PTCy) and conventional graft-versus-host-disease (GVHD) prophylaxis, respectively. In multivariate analysis, use of younger haploidentical donors was associated with improved overall survival (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.69-0.95, p = .01) and lower rates of grade II-IV acute GVHD (HR 0.64, 95% CI 0.53-0.77, p < .001), grade III-IV acute GVHD (HR 0.37, 95% CI 0.25-0.53, p < .001), and chronic GVHD (HR 0.49, 95% CI 0.40-0.60, p < .001). Relapse rates were similar among those who received myeloablative conditioning but were higher in patients of the younger haploidentical group who received reduced intensity conditioning (HR 1.49, 95%CI 1.18-1.88, p = .001). The younger haploidentical group had significantly lower non-relapse mortality ≥3 months post-HCT (HR 0.59, 95% CI 0.38-0.90, p = .02). Our data support the use of younger haploidentical donors with PTCy over older MUDs with conventional prophylaxis in patients with MDS or AML. Further studies on the importance of donor age in haploidentical and MUD HCT with PTCy prophylaxis are warranted.