Double umbilical cord blood transplantation with reduced intensity conditioning and sirolimus-based GVHD prophylaxis

被引：76

作者：

Cutler, C. ^{[1
]}

Stevenson, K. ^{[2
]}

Kim, H. T. ^{[2
]}

Brown, J. ^{[3
]}

McDonough, S. ^{[1
]}

Herrera, M. ^{[1
]}

Reynolds, C. ^{[1
]}

Liney, D. ^{[1
]}

Kao, G. ^{[1
]}

Ho, V. ^{[1
]}

Armand, P. ^{[1
]}

Koreth, J. ^{[1
]}

Alyea, E. ^{[1
]}

Dey, B. R. ^{[4
]}

Attar, E. ^{[4
]}

Spitzer, T. ^{[4
]}

Boussiotis, V. A. ^{[3
]}

Ritz, J. ^{[1
]}

Soiffer, R. ^{[1
]}

Antin, J. H. ^{[1
]}

Ballen, K. ^{[4
]}

机构：

[1] Dana Farber Canc Inst, Dept Med Oncol, Boston, MA 02115 USA

[2] Dana Farber Canc Inst, Dept Biostat & Computat Biol, Boston, MA 02115 USA

[3] Beth Israel Deaconess Med Ctr, Dept Med, Div Hematol Oncol & Canc Biol, Boston, MA 02215 USA

[4] Massachusetts Gen Hosp, Dept Med, Div Hematol Oncol, Boston, MA 02114 USA

来源：

BONE MARROW TRANSPLANTATION | 2011年 / 46卷 / 05期

关键词：

umbilical cord blood; graft-vs-host disease; sirolimus; STEM-CELL TRANSPLANTATION; VERSUS-HOST-DISEASE; EPSTEIN-BARR-VIRUS; POSTTRANSPLANT LYMPHOPROLIFERATIVE DISEASE; BONE-MARROW; THYMIC FUNCTION; IMMUNE RECONSTITUTION; LYMPHOID MALIGNANCIES; UNRELATED DONORS; RISK-FACTORS;

D O I：

10.1038/bmt.2010.192

中图分类号：

Q6 [生物物理学];

学科分类号：

071011 ;

摘要：

The main limitations to umbilical cord blood (UCB) transplantation (UCBT) in adults are delayed engraftment, poor immunological reconstitution and high rates of non-relapse mortality (NRM). Double UCBT (DUCBT) has been used to circumvent the issue of low cell dose, but acute GVHD remains a significant problem. We describe our experience in 32 subjects, who underwent DUCBT after reduced-intensity conditioning with fludarabine/melphalan/antithymocyte globulin and who received sirolimus and tacrolimus to prevent acute GVHD. Engraftment of neutrophils occurred in all patients at a median of 21 days, and platelet engraftment occurred at a median of 42 days. Three subjects had grade II-IV acute GVHD (9.4%) and chronic GVHD occurred in four subjects (cumulative incidence 12.5%). No deaths were caused by GVHD and NRM at 100 days was 12.5%. At 2 years, NRM, PFS and OS were 34.4, 31.2 and 53.1%, respectively. As expected, immunologic reconstitution was slow, but PFS and OS were associated with reconstitution of CD4(+) and CD8(+) lymphocyte subsets, suggesting that recovery of adaptive immunity is required for the prevention of infection and relapse after transplantation. In summary, sirolimus and tacrolimus provide excellent GVHD prophylaxis in DUCBT, and this regimen is associated with low NRM after DUCBT. Bone Marrow Transplantation (2011) 46, 659-667; doi:10.1038/bmt.2010.192; published online 9 August 2010

引用

页码：659 / 667

页数：9

共 32 条

[1] Improved Survival in Lymphoma Patients Receiving Sirolimus for Graft-Versus-Host Disease Prophylaxis After Allogeneic Hematopoietic Stem-Cell Transplantation With Reduced-Intensity Conditioning [J].