Abstract：
In the context of T-cell replete haploidentical stem cell transplantation (Haplo-SCT) using post-transplantation cyclophosphamide (PT-Cy), it is still unknown whether peripheral blood (PB) or bone marrow (BM) is the best graft source. While PB is associated with a higher incidence of graft-versus-host disease (GVHD), it may induce a stronger graft-versus-leukemia effect compared to BM, notably in acute myeloid leukemia (AML). From the EBMT registry database, we compared T-cell replete PB (n = 595) versus BM (n = 209) grafts in a large cohort of 804 patients over the age of 60 years who underwent Haplo-SCT with PT-Cy for an AML in first or second complete remission. The risk of acute GVHD was significantly higher in the PB group (Grade II-IV: HR = 1.67, 95% CI [1.10-2.54], p = 0.01; Grade III-IV: HR = 2.29, 95% CI [1.16-4.54], p = 0.02). No significant difference was observed in chronic GVHD or non-relapse mortality. In the PB group, the risk of relapse was significantly lower in the PB group (HR = 0.65, 95% CI [0.45-0.94], p = 0.02) and leukemia-free survival was significantly better (HR = 0.76, 95% CI [0.59-0.99], p = 0.04), with a trend toward better overall survival (HR = 0.78, 95% CI [0.60-1.01], p = 0.06). We conclude that in the specific context of Haplo-SCT with PT-Cy, PB grafts represent a valid option to decrease the risk of relapse and improve outcome of older AML patients who usually do not benefit from conditioning intensification.
摘要：
在使用移植后环磷酰胺（PT-Cy）的T细胞充分单倍体干细胞移植（Haplo-SCT）的情况下，尚不清楚外周血（PB）或骨髓（BM）是否是最佳的移植物来源。虽然PB与移植物抗宿主病（GVHD）的发病率较高有关，与BM相比，它可能会诱导更强的移植物抗白血病效应，特别是在急性髓细胞性白血病（AML）。从EBMT注册表数据库中，我们比较了804例60岁以上患者的T细胞充足PB(n=595)和BM(n=209)移植物,这些患者接受了Haplo-SCT和PT-Cy治疗AML首次或第二次完全缓解.PB组发生急性GVHD的风险明显更高(II-IV级:HR=1.67,95%CI[1.10-2.54],p=0.01；III-IV级：HR=2.29，95%CI[1.16-4.54]，p=0.02)。在慢性GVHD或非复发死亡率中没有观察到显著差异。在PB组中，PB组的复发风险显着降低（HR=0.65，95％CI[0.45-0.94]，p=0.02），无白血病生存率明显更好（HR=0.76，95％CI[0.59-0.99]，p=0.04),总体生存率有改善的趋势(HR=0.78，95%CI[0.60-1.01]，p=0.06)。我们得出的结论是，在带PT-Cy的Haplo-SCT的特定背景下，PB移植是降低复发风险和改善老年AML患者预后的有效选择，这些患者通常不会从调理强化中受益。
