多平台异体造血干细胞移植的比较结果，突出使用移植后环磷酰胺的半同源移植在成人T细胞白血病/淋巴瘤中的应用

Comparative outcomes of various transplantation platforms, highlighting haploidentical transplants with post-transplantation cyclophosphamide for adult T-cell leukaemia/lymphoma

BRITISH JOURNAL OF HAEMATOLOGY

影响因子:3.8

分区:医学2区 / 血液学2区

发表日期:2025 Jan

作者: Makoto Yoshimitsu, Takashi Tanaka, Nobuaki Nakano, Koji Kato, Hiroyuki Muranushi, Masahito Tokunaga, Ayumu Ito, Jun Ishikawa, Tetsuya Eto, Satoko Morishima, Toshiro Kawakita, Hidehiro Itonaga, Naoyuki Uchida, Masatsugu Tanaka, Keiichi Akizuki, Kenji Ishitsuka, Hiroyuki Ohigashi, Shuichi Ota, Toshihiko Ando, Yoshinobu Kanda, Takahiro Fukuda, Yoshiko Atsuta, Shigeo Fuji,

DOI: 10.1111/bjh.19835

摘要

本研究回顾性比较了成人T细胞白血病/淋巴瘤患者多种异基因造血细胞移植（allo-HCT）平台的效果，包括使用移植后环磷酰胺（PTCY）的HLA-半合子配型相关供者（HLA-haploidentical），HLA匹配相关供者（MRD），HLA匹配无关供者（MUD）和脐带血移植（CBT）。纳入2016年至2021年进行的首次allo-HCT患者。分析指标包括总生存（OS）、复发及非复发死亡（NRM）。共纳入700例患者（PTCY，121例；MRD，91例；MUD，160例；CBT，328例）。随访中位数为794天，2年OS率分别为48.1%（PTCY）、48.8%（MRD）、48.4%（MUD）和34.6%（CBT）；2年累计复发率分别为37.1%、47.5%、33.9%和45.1%；NRM分别为24.2%、19.8%、24.7%和27.3%。与MRD和MUD相比，PTCY组的血小板植入延迟，但未增加严重急性或慢性移植物抗宿主病的发生。在PTCY组中，表现不佳的状态是预示较差OS的重要预测因子，输注CD34+细胞少于5×10^6/公斤则与中性粒细胞和血小板植入延迟相关。这些结果表明，使用PTCY的allo-HCT是一种安全有效的治疗成人T细胞白血病/淋巴瘤的平台。

Abstract

This study retrospectively compared outcomes of various allogeneic haematopoietic cell transplantation (allo-HCT) platforms in patients with adult T-cell leukaemia/lymphoma. Platforms included human leukocyte antigen (HLA)-haploidentical-related donors using post-transplant cyclophosphamide (PTCY), HLA-matched related donors (MRD), HLA-matched unrelated donors (MUD) and cord blood transplantation (CBT). Patients who underwent their first allo-HCT between 2016 and 2021 were included. Outcomes analysed were overall survival (OS), relapse and non-relapse mortality (NRM). Seven hundred patients were included (PTCY, n = 121; MRD, n = 91; MUD, n = 160; CBT, n = 328). With a median follow-up of 794 days for survivors, 2-year OS was 48.1% (PTCY), 48.8% (MRD), 48.4% (MUD) and 34.6% (CBT); the respective 2-year cumulative incidence of relapse was 37.1%, 47.5%, 33.9% and 45.1% and that of NRM was 24.2%, 19.8%, 24.7% and 27.3%. PTCY was associated with delayed platelet engraftment relative to MRD and MUD. There was no increase in the incidence of severe acute or chronic graft-versus-host disease. In the PTCY group, poor performance status was a significant predictor of inferior OS, and infused CD34+ cell numbers of less than 5 × 106/kg were associated with delayed neutrophil and platelet engraftment. These results suggest that allo-HCT with PTCY is a safe and effective platform for patients with adult T-cell leukaemia/lymphoma.