The graft-versus-leukemia effect using matched unrelated donors is not superior to HLA-identical siblings for hematopoietic stem cell transplantation

被引：124

作者：

Ringden, Olle ^{[1
]}

Pavletic, Steven Z. ^{[2
]}

Anasetti, Claudio ^{[3
]}

Barrett, A. John ^{[2
]}

Wang, Tao ^{[4
]}

Wang, Dan ^{[4
]}

Antin, Joseph H. ^{[5
]}

Di Bartolomeo, Paolo ^{[6
]}

Bolwell, Brian J. ^{[7
]}

Bredeson, Christopher ^{[4
]}

Cairo, Mitchell S. ^{[8
]}

Gale, Robert P. ^{[9
]}

Gupta, Vikas ^{[10
]}

Hahn, Theresa ^{[11
]}

Hale, Gregory A. ^{[12
]}

Halter, Jorg ^{[13
]}

Jagasia, Madan ^{[14
]}

Litzow, Mark R. ^{[15
]}

Locatelli, Franco ^{[16
]}

Marks, David I. ^{[17
]}

McCarthy, Philip L. ^{[11
]}

Cowan, Morton J. ^{[18
]}

Petersdorf, Effie W. ^{[19
]}

Russell, James A. ^{[20
]}

Schiller, Gary J. ^{[21
]}

Schouten, Harry ^{[22
]}

Spellman, Stephen ^{[4
]}

Verdonck, Leo F. ^{[23
]}

Wingard, John R. ^{[24
]}

Horowitz, Mary M. ^{[4
]}

Arora, Mukta ^{[25
]}

机构：

[1] Karolinska Univ, Huddinge Hosp, Karolinska Inst, Div Clin Immunol,Ctr Allogene Stem & Cell Transpl, SE-14186 Stockholm, Sweden

[2] NIH, Expt Transplantat & Immunol Branch, Bethesda, MD 20892 USA

[3] H Lee Moffitt Canc Ctr & Res Inst, BMT Program, Tampa, FL USA

[4] Med Coll Wisconsin, CIBMTR, Milwaukee, WI 53226 USA

[5] Brigham & Womens Hosp, Dana Farber Canc Inst, Boston, MA 02115 USA

[6] Osped Civile, Dept Haematol, Pescara, Italy

[7] Cleveland Clin Fdn, Cleveland, OH USA

[8] Columbia Univ, Med Ctr, New York, NY USA

[9] Ctr Adv Studies Leukemia, Los Angeles, CA USA

[10] Princess Margaret Hosp, BMT Program, Toronto, ON M4X 1K9, Canada

[11] Roswell Pk Canc Inst, Dept Med, Buffalo, NY 14263 USA

[12] St Jude Childrens Hosp, Memphis, TN 38105 USA

[13] Univ Basel Hosp, CH-4031 Basel, Switzerland

[14] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[15] Mayo Clin, Rochester, MN USA

[16] Policlin San Matteo, IRCCS, I-27100 Pavia, Italy

[17] United Bristol Healthcare Trust, Adult BMT Unit, Bristol, Avon, England

[18] Univ Calif San Francisco, Childrens Hosp, BMT Div, San Francisco, CA 94143 USA

[19] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA

[20] Tom Baker Canc Clin, Dept Med, Calgary, AB, Canada

[21] Univ Calif Los Angeles, Sch Med, Los Angeles, CA 90024 USA

[22] Univ Hosp Maastricht, Maastricht, Netherlands

[23] Univ Utrecht Hosp, Utrecht, Netherlands

[24] Univ Florida, Coll Med, Hlth Sci Ctr, Gainesville, FL USA

[25] Univ Minnesota, Minneapolis, MN USA

来源：

BLOOD | 2009年 / 113卷 / 13期

关键词：

BONE-MARROW-TRANSPLANTATION; MINOR HISTOCOMPATIBILITY ANTIGENS; CHRONIC MYELOGENOUS LEUKEMIA; ACUTE LYMPHOBLASTIC-LEUKEMIA; HOST-DISEASE; CYCLOSPORINE-A; INCREASED RISK; DOSE CYCLOSPORINE; MYELOID-LEUKEMIA; RELAPSE;

D O I：

10.1182/blood-2008-07-163212

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Do some patients benefit from an unrelated donor (URD) transplant because of a stronger graft-versus-leukemia (GVL) effect? We analyzed 4099 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and chronic myeloid leukemia (CML) undergoing a myeloablative allogeneic hematopoietic cell transplantation (HCT) from an URD (8/8 human leukocyte antigen [HLA]matched, n = 941) or HLA-identical sibling donor (n = 3158) between 1995 and 2004 reported to the CIBMTR. In the Cox regression model, acute and chronic GVHD were added as time-dependent variables. In multivariate analysis, URD transplant recipients had a higher risk for transplantation-related mortality (TRM; relative risk [RR], 2.76; P < .001) and relapse (RR, 1.50; P < .002) in patients with AML, but not ALL or CML. Chronic GVHD was associated with a lower relapse risk in all diagnoses. Leukemia-free survival (LFS) was decreased in patients with AML without acute GVHD receiving a URD transplant (RR, 2.02; P < .001) but was comparable to those receiving HLA-identical sibling transplants in patients with ALL and CML. In patients without GVHD, multivariate analysis showed similar risk of relapse but decreased LFS for URD transplants for all 3 diagnoses. In conclusion, risk of relapse was the same (ALL, CML) or worse (AML) in URD transplant recipients compared with HLA-identical sibling transplant recipients, suggesting a similar GVL effect. (Blood. 2009; 113: 3110-3118)

引用

页码：3110 / 3118

页数：9

共 38 条

[1]

ASCHAN J, 1991, BONE MARROW TRANSPL, V7, P113

[2]

ASCHAN J, 1993, EUR J HAEMATOL, V50, P269

[3]

ATKINSON K, 1990, BLOOD, V75, P2459

[4]

BACIGALUPO A, 1991, BLOOD, V77, P1423

[5] Low-dose cyclosporine of short duration increases the risk of mild and moderate GVHD and reduces the risk of relapse in HLA-identical sibling marrow transplant recipients with leukaemia [J].

Carlens, S ;

Aschan, J ;

Remberger, M ;

Dilber, MS ;

Ringdén, O .

BONE MARROW TRANSPLANTATION, 1999, 24 (06) :629-635

[6] Natural killer cell receptors: new biology and insights into the graft-versus-leukemia effect [J].

Farag, SS ;

Fehniger, TA ;

Ruggeri, L ;

Velardi, A ;

Caligiuri, MA .

BLOOD, 2002, 100 (06) :1935-1947

[7] ADOPTIVE CHEMOIMMUNOTHERAPY OF CANCER IN ANIMALS - REVIEW OF RESULTS, PRINCIPLES, AND PROBLEMS [J].

FEFER, A ;

EINSTEIN, AB ;

CHEEVER, MA .

ANNALS OF THE NEW YORK ACADEMY OF SCIENCES, 1976, 277 (SEP20) :492-504

[8]

FEFER A, 1987, CELLULAR IMMUNOTHERA, P401

[9]

GALE RP, 1995, BONE MARROW TRANSPL, V16, P203

[10] IDENTICAL-TWIN BONE-MARROW TRANSPLANTS FOR LEUKEMIA [J].

GALE, RP ;

HOROWITZ, MM ;

ASH, RC ;

CHAMPLIN, RE ;

GOLDMAN, JM ;

RIMM, AA ;

RINGDEN, O ;

STONE, JAV ;

BORTIN, MM .

ANNALS OF INTERNAL MEDICINE, 1994, 120 (08) :646-652

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