《对于急性淋巴细胞白血病患者进行全基因相合无关供者异基因造血细胞移植中, 比较而言，使用术后环磷酰胺与使用抗胸腺球蛋白》. 一项来自欧洲血液与骨髓移植学会急性白血病工作小组的研究.
Posttransplant cyclophosphamide versus antithymocyte globulin in patients with acute lymphoblastic leukemia treated with allogeneic hematopoietic cell transplantation from matched unrelated donors. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation.
发表日期：2023 Sep 01
作者：
Sebastian Giebel, Myriam Labopin, Urpu Salmenniemi, Gerard Socié, Sergey Bondarenko, Didier Blaise, Nicolaus Kröger, Jan Vydra, Anna Grassi, Francesca Bonifazi, Tomasz Czerw, Achilles Anagnostopoulos, Bruno Lioure, Annalisa Ruggeri, Bipin Savani, Alexandros Spyridonidis, Jaime Sanz, Zinaida Peric, Arnon Nagler, Fabio Ciceri, Mohamad Mohty
来源：
CANCER
摘要：
本研究的目的是比较两种免疫抑制策略，基于使用兔抗胸腺细胞球蛋白（ATG）或移植后环磷酰胺（PTCY），作为急性淋巴细胞性白血病（ALL）患者第一次完全缓解后接受同种异基因造血细胞移植的预防移植物抗宿主病（GVHD）。总体而言，本回顾性研究包括在2015年至2020年期间接受PTCY和ATG治疗的117和779名成年患者。PTCY组和ATG组的患者中位年龄分别为40岁和43岁，其中37%和35%的患者为Philadelphia染色体阳性ALL。单变量分析显示，急性和慢性GVHD的累积发生率在两个研究组之间没有显著差异。2年内复发的累积发生率在PTCY组中降低（18% vs. 25%; p = .046），对ATG组的非复发性死亡率没有显著影响（11% vs. 16%; p = .29）。白血病无病生存率（LFS）和总体生存率分别为71%和59%（p = .01），82%和74%（p = .08）。多变量分析显示，与PTCY组相比，接受ATG治疗与广泛慢性GVHD的风险降低（风险比0.54，95%置信区间0.3-0.98; p = .04），低LFS的风险增加（风险比1.57，95%置信区间1.01-2.45; p = .045）。尽管ATG组的广泛慢性GVHD风险降低，但与PTCY组相比，接受ATG治疗的成年ALL患者的LFS较差。这些结果需要在前瞻性试验中进行验证。© 2023 American Cancer Society.
The aim of this study was to compare two immunosuppressive strategies, based on the use of either rabbit antithymocyte globulin (ATG) or posttransplant cyclophosphamide (PTCY), as a prophylaxis of graft-versus-host disease (GVHD) for patients with acute lymphoblastic leukemia (ALL) in first complete remission who underwent hematopoietic cells transplantation from matched unrelated donors.Overall, 117 and 779 adult patients who received PTCY and ATG, respectively, between the years 2015 and 2020 were included in this retrospective study. The median patient age was 40 and 43 years in the PTCY and ATG groups, respectively, and 37% and 35% of patients, respectively, had Philadelphia chromosome-positive ALL.In univariate analysis, the cumulative incidence of acute and chronic GVHD did not differ significantly between the study groups. The cumulative incidence of relapse at 2 years was reduced in the PTCY group (18% vs. 25%; p = .046) without a significant impact on nonrelapse mortality (11% vs. 16% in the ATG group; p = .29). The rates of leukemia-free survival (LFS) and overall survival were 71% versus 59%, respectively (p = .01), and 82% versus 74%, respectively (p = .08). In multivariate analysis, the receipt of ATG compared with PTCY was associated with a reduced risk of extensive chronic GVHD (hazard ratio, 0.54; 95% confidence interval, 0.3-0.98; p = .04) and an increased risk of low LFS (hazard ratio, 1.57; 95% confidence interval, 1.01-2.45; p = .045).The receipt of ATG compared with PTCY, despite the reduced risk of extensive chronic GVHD, is associated with inferior LFS in adults with ALL who undergo hematopoietic cell transplantation from 10/10 human leukocyte antigen-matched unrelated donors. These findings warrant verification in prospective trials.© 2023 American Cancer Society.