比较 ALL 患者在失配相关或不相关的供体环境中进行清髓性调节后的移植结果。
Comparing transplant outcomes in ALL patients after myeloablative conditioning in mismatch-related or unrelated donor settings.
发表日期：2024 Aug 15
作者：
Salman Otoukesh, Dongyun Yang, Sally Mokhtari, Hoda Pourhassan, Vaibhav Agrawal, Shukaib Arslan, Idoroenyi Amanam, Brian Ball, Paul Koller, Amandeep Salhotra, Karamjeet Sandhu, Ahmed Aribi, Andrew Artz, Ibrahim Aldoss, Vinod Pullarkat, Haris Ali, Amanda Blackmon, Pamela Becker, Peter Curtin, Forrest Stewart, Eileen Smith, Anthony Stein, Guido Marcucci, Stephen J Forman, Ryotaro Nakamura, Monzr M Al Malki
来源：
Bone & Joint Journal
摘要：
对于接受替代供者造血细胞移植 (HCT) 的 ALL 患者来说，最佳的清髓预处理方案尚不清楚。我们分析了 2010 年至 2020 年在我们中心接受 HCT 的所有患者 (n = 269)，在 FTBI-依托泊苷和基于 CNI 的 GvHD 预防匹配供体 HCT 后完全缓解 (CR)（ETOP 包；n = 196）或针对 HLA 不匹配（相关或不相关）供体的 FTBI-氟达拉滨和基于移植后环磷酰胺 (PTCy) 的预防（FLU 包；n = 64）。 FLU 套餐中的患者表现出植入显着延迟（p<0.001），任何和广泛慢性 GVHD 的累积发生率 (CI) 较低（分别为 p=0.009 和 0.001）。中位随访时间为 4.6 年（范围 1-12 年）；非复发死亡率、总生存期或无白血病生存期以及无 GVHD/无复发生存期并未受到预处理选择的显着影响。然而，在 CR2 或具有可测量残留病灶 (MRD) 的患者中，FLU 治疗后有较高的复发趋势（分别为 p = 0.08 和 p = 0.07），而 CR1 的患者，无论 MRD 状态如何，都有相似的结果包/捐助者类型（分别为 p = 0.9 和 0.7）。我们的数据表明，针对替代捐赠者的 FLU 套餐与针对匹配捐赠者 HCT 的 ETOP 套餐在治疗 ALL 方面提供了可比的结果。 HCT 时的疾病状态和缓解深度是更好结果的独立预测因素。© 2024。作者。
The optimal myeloablative conditioning regimen for ALL patients undergoing hematopoietic cell transplant (HCT) with an alternative donor is unknown. We analyzed HCT outcomes ALL patients (n = 269) who underwent HCT at our center from 2010 to 2020 in complete remission (CR) after FTBI-etoposide and CNI-based GvHD prophylaxis for matched donor HCT (ETOP-package; n = 196) or FTBI-Fludarabine and post-transplant cyclophosphamide (PTCy)-based prophylaxis for HLA- mismatched (related or unrelated) donors (FLU-package; n = 64). Patients in FLU-package showed a significant delay in engraftment (p < 0.001) and lower cumulative incidence (CI) of any and extensive chronic GVHD (p = 0.009 and 0.001, respectively). At the median follow up of 4.6 years (range 1-12 years); non-relapse mortality, overall or leukemia-free survival and GVHD-free/relapse-free survival were not significantly impacted by the choice of conditioning. However, in patients at CR2 or with measurable residual disease (MRD+), there was a trend towards higher relapse after FLU-package (p = 0.08 and p = 0.07, respectively), while patients at CR1 regardless of MRD status had similar outcomes despite the package/donor type (p = 0.9 and 0.7, respectively). Our data suggests that FLU-package for alternative donors offers comparable outcomes to ETOP-package for matched donor HCT to treat ALL. Disease status and depth of remission at HCT were independent predictors for better outcomes.© 2024. The Author(s).