低毒性预处理(RIC)方案用于老年患者的异基因造血干细胞移植。然而,成功的结果受到移植物抗宿主病(GVHD)的阻碍,治疗相关死亡率,和复发,特别是在单倍型供体造血干细胞移植(HID-HSCT)后。这项研究的目的是评估RIC预处理方案的有效性,其中包括环孢菌素A的组合,甲氨蝶呤(第1天),霉酚酸酯,较低剂量的移植后PTCy(第3天40mg/kg),和ATG(7.5mg/kg)作为老年患者单plo干细胞移植(单plo-SCT)之前的GVHD预防。
方法:我们回顾性分析了55例年龄≥55岁的恶性血液病患者接受氟达拉滨治疗的结局,阿糖胞苷,白消安,并在2019年1月1日至2023年11月30日期间使用低剂量环磷酰胺作为预处理方案。
结果:所有患者在28天内均成功植入中性粒细胞,54例患者(98.2%)实现完全供体嵌合。30天非复发死亡率的累积发生率为0%,100天的7.5%,1年的19%。II-IV级急性移植物抗宿主病(aGVHD)的累积发生率为25%(95CI,15-38%),而III-IV级aGVHD为9.1%(95%CI,3.3-19%).1年时广泛慢性移植物抗宿主病的累积发病率为3.6%(95CI,0.66-11%)。复发的累积发生率,总生存率,1年无GVHD/无复发生存率为9.0%,71.6%,和67.1%,分别。
结论:RIC预处理方案,包括较低的PTCy/ATG作为GVHD预防的组合,其次是haplo-SCT,对于适当选择的老年患者可能是一个有希望的选择。
Reduced-toxicity conditioning (RIC) regimens are used for allogeneic hematopoietic stem cell transplantation in older patients. However, successful outcomes are hindered by graft-versus-host disease (GVHD), treatment-related mortality, and relapse, particularly after haploidentical donor hematopoietic stem cell transplantation (HID-HSCT). The aim of this study was to evaluate the effectiveness of an RIC conditioning regimen that included a combination of cyclosporin A, methotrexate (on day + 1), mycophenolate, lower doses of post-transplantation PTCy (40 mg/kg on day + 3), and ATG (7.5 mg/kg) as GVHD prophylaxis prior to haplo-stem cell transplantation (haplo-SCT) in older patients.
METHODS: We retrospectively analyzed outcomes in 55 patients ≥ 55 years of age with hematologic malignancies treated with fludarabine, cytarabine, busulfan, and low-dose cyclophosphamide as the conditioning regimen between January 1, 2019, and November 30, 2023.
RESULTS: Neutrophil engraftment was successful in all patients within 28 days, with 54 patients (98.2%) achieving complete donor chimerism. The cumulative incidence of non-relapse mortality was 0% at 30 days, 7.5% at 100 days, and 19% at 1 year. The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) was 25% (95%CI, 15-38%), whereas that of grade III-IV aGVHD was 9.1% (95% CI, 3.3-19%). The cumulative incidence of extensive chronic graft-versus-host disease at 1 year was 3.6% (95%CI, 0.66-11%). The cumulative incidences of relapse, overall survival, and GVHD-free/relapse-free survival at 1 year were 9.0%, 71.6%, and 67.1%, respectively.
CONCLUSIONS: An RIC conditioning regimen, including a combination of lower PTCy/ATG as GVHD prophylaxis, followed by haplo-SCT, might be a promising option for appropriately selected older patients.