对于首次完全缓解的急性髓系白血病患者，使用基于环磷酰胺的移植后移植物抗宿主病预防措施的不匹配的无关供体移植后的存活率比使用双单位脐带血的存活率更高：来自欧洲急性白血病工作组的一项研究血液和骨髓移植协会。
Higher survival following transplantation with a mismatched unrelated donor with posttransplant cyclophosphamide-based graft-versus-host disease prophylaxis than with double unit umbilical cord blood in patients with acute myeloid leukemia in first complete remission: A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
发表日期：2024 Aug 31
作者：
Frédéric Baron, Myriam Labopin, Jurjen Versluis, Jan Vydra, Peter A von dem Borne, Emma Nicholson, Didier Blaise, Rachel Protheroe, Alexander Kulagin, Claude Eric Bulabois, Montserrat Rovira, Patrice Chevallier, Edouard Forcade, Jenny Byrne, Jaime Sanz, Annalisa Ruggeri, Mohamad Mohty, Fabio Ciceri
来源：
AMERICAN JOURNAL OF HEMATOLOGY
摘要：
对于缺乏 HLA 匹配供体的急性髓系白血病 (AML) 患者的最佳供体选择仍然存在激烈争论。我们在此报告了一项大型回顾性登记研究的结果，该研究比较了双单位脐带血移植（dCBT，n = 209）与移植后环磷酰胺的 9/10 HLA 匹配的无关供体（UD）之间的造血细胞移植（HCT）结果（在首次完全缓解 (CR1) 的 AML 患者中进行基于 PTCy 的移植物抗宿主病 (GVHD) 预防 (UD 9/10, n = 270)。纳入标准包括成年患者、移植时 CR1 中的 AML、来自 UD 9/10 的外周血干细胞 (PBSC)，使用 PTCy 作为 GVHD 预防或不使用 PTCy 的 dCBT，2013 年至 2021 年间进行移植，且体内无 T 细胞耗竭。 UD 9/10 中 II-IV 级急性 GVHD 的 180 天累积发生率为 29%，而 dCBT 接受者为 44% (p = .001)。调整协变量后，dCBT 接受者的非复发死亡率较高（HR = 2.35，95% CI：1.23-4.48；p = .01），复发率相当（HR = 1.12，95% CI：0.67-1.86；p = .66)、较低的无白血病生存率 (HR = 1.5, 95% CI: 1.01-2.23; p = .047) 和较低的总生存率 (HR = 1.66, 95% CI: 1.08-2.55; p = .02 ）与接受 UD 9/10 HCT 的患者进行比较。总之，我们的结果表明，对于 CR1 期 AML 患者，使用基于 PTCy 的 GVHD 预防的 UD 9/10 移植结果优于 dCBT。这些数据可能支持在缺乏 HLA 匹配供体的 AML 患者中使用 UD 9/10 和基于 PTCy 的 GVHD 预防，而不是 dCBT。© 2024 Wiley periodicals LLC。
The best donor option for acute myeloid leukemia (AML) patients lacking an HLA-matched donor has remained intensively debated. We herein report the results of a large retrospective registry study comparing hematopoietic cell transplantation (HCT) outcomes between double-unit umbilical cord blood transplantation (dCBT, n = 209) versus 9/10 HLA-matched unrelated donor (UD) with posttransplant cyclophosphamide (PTCy)-based graft-versus-host disease (GVHD) prophylaxis (UD 9/10, n = 270) in patients with AML in first complete remission (CR1). Inclusion criteria consisted of adult patient, AML in CR1 at transplantation, either peripheral blood stem cells (PBSC) from UD 9/10 with PTCy as GVHD prophylaxis or dCBT without PTCy, transplantation between 2013 and 2021, and no in vivo T-cell depletion. The 180-day cumulative incidence of grade II-IV acute GVHD was 29% in UD 9/10 versus 44% in dCBT recipients (p = .001). After adjustment for covariates, dCBT recipients had a higher non-relapse mortality (HR = 2.35, 95% CI: 1.23-4.48; p = .01), comparable relapse incidence (HR = 1.12, 95% CI: 0.67-1.86; p = .66), lower leukemia-free survival (HR = 1.5, 95% CI: 1.01-2.23; p = .047), and lower overall survival (HR = 1.66, 95% CI: 1.08-2.55; p = .02) compared with patients receiving UD 9/10 HCT. In summary, our results suggest that transplantation outcomes are better with UD 9/10 with PTCy-based GVHD prophylaxis than with dCBT for AML patients in CR1. These data might support the use of UD 9/10 with PTCy-based GVHD prophylaxis over dCBT in AML patients lacking an HLA-matched donor.© 2024 Wiley Periodicals LLC.