HLA-mismatched stem-cell microtransplantation as postremission therapy for acute myeloid leukemia: long-term follow-up
| Autor: | Tie-Qiang Liu, Jun-Xiao Qiao, Zhiqing Liu, Jian-Hui Qiao, Chang-Lin Yu, Bing Liu, Mei Guo, Juan Wang, Li Wei, Guang-xian Liu, Wan-Jun Sun, Qiu-Hong Man, Hong-Li Zuo, Xue-Dong Sun, Zheng Dong, Hong-Xia Zhao, Ya-Jing Huang, Kai-Xun Hu, Hui-Sheng Ai, Qi-Yun Sun, Xuliang Shen |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Cancer Research medicine.medical_specialty Myeloid Adolescent medicine.medical_treatment Graft vs Host Disease Hematopoietic stem cell transplantation Gastroenterology Disease-Free Survival Young Adult Internal medicine Antineoplastic Combined Chemotherapy Protocols Granulocyte Colony-Stimulating Factor HLA-A2 Antigen Medicine Humans Child Aged Transplantation Chimera business.industry Remission Induction Hematopoietic Stem Cell Transplantation Myeloid leukemia Microchimerism Middle Aged medicine.disease Combined Modality Therapy Microtransplantation Tissue Donors Surgery Granulocyte colony-stimulating factor Leukemia Leukemia Myeloid Acute medicine.anatomical_structure Oncology Cytarabine Blood Component Removal Female business medicine.drug Follow-Up Studies |
| Zdroj: | Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 30(33) |
| ISSN: | 1527-7755 |
| Popis: | Purpose Despite best current therapies, approximately half of patients with acute myeloid leukemia in first complete remission (AML-CR1) with no HLA-identical donors experience relapse. Whether HLA-mismatched stem-cell microtransplantation as a novel postremission therapy in these patients will improve survival and avoid graft-versus-host disease (GVHD) is still unknown. Patients and Methods One hundred one patients with AML-CR1 (9 to 65 years old) from four treatment centers received programmed infusions of G-CSF–mobilized HLA-mismatched donor peripheral-blood stem cells after each of three cycles of high-dose cytarabine conditioning without GVHD prophylaxis. Donor chimerism and microchimerism and WT1+CD8+ T cells were analyzed. Results The 6-year leukemia-free survival (LFS) and overall survival (OS) rates were 84.4% and 89.5%, respectively, in the low-risk group, which were similar to the rates in the intermediate-risk group (59.2% and 65.2%, respectively; P = .272 and P = .308). The 6-year LFS and OS were 76.4% and 82.1%, respectively, in patients who received a high dose of donor CD3+ T cells (≥ 1.1 × 108/kg) in each infusion, which were significantly higher than the LFS and OS in patients who received a lower dose (< 1.1 × 108/kg) of donor CD3+ T cells (49.5% and 55.3%, respectively; P = .091 and P = .041). No GVHD was observed in any of the patients. Donor microchimerism (2 to 1,020 days) was detected in 20 of the 23 female patients who were available for Y chromosome analysis. A significant increase in WT1+CD8+ T cells (from 0.2% to 4.56%) was observed in 33 of 39 patients with positive HLA-A*02:01 antigen by a pentamer analysis. Conclusion Microtransplantation as a postremission therapy may improve outcomes and avoid GVHD in patients with AML-CR1. |
| Databáze: | OpenAIRE |
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