Impact of Donor Source on Allogeneic Hematopoietic Stem Cell Transplantation for Mature T Cell and Natural Killer Cell Neoplasms in the Kyoto Stem Cell Transplantation Group

Mizuki Watanabe , Junya Kanda , Yasuyuki Arai , Masakatsu Hishizawa , Momoko Nishikori , Takayuki Ishikawa , Kazunori Imada , Yasunori Ueda , Takashi Akasaka , Akihito Yonezawa , Masaharu Nohgawa , Toshiyuki Kitano , Mitsuru Itoh , Tomoharu Takeoka , Toshinori Moriguchi , Kazuhiro Yago , Nobuyoshi Arima , Naoyuki Anzai , Mitsumasa Watanabe , Tadakazu Kondo , Akifumi Takaori-Kondo
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引用次数: 3

Abstract

Although allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the key strategy to cure patients with mature T and natural killer (NK) cell lymphomas/leukemia, especially those with relapsed/refractory diseases, there is no consensus strategy for donor selection. We retrospectively analyzed the outcomes of allo-HSCT in 111 patients in 15 Japanese institutions as a multi-institutional joint research project. Thirty-nine patients received bone marrow or peripheral blood stem cell transplantation from related donors (rBMT/rPBSCT), 37 received BMT/PBSCT from unrelated donors (uBMT/uPBSCT), and 35 received cord blood transplantation (CBT). Overall survival (OS) and progression-free survival (PFS) at 4 years were 42% and 34%, respectively. The cumulative incidences of relapse and nonrelapse mortality were 43% and 25%. In multivariate analysis, CBT showed comparable OS with rBMT/rPBSCT (rBMT/rPBSCT versus CBT: hazard ratio [HR], 1.63; P = .264) and better OS compared with uBMT/uPBSCT (HR, 2.99; P = .010), with a trend toward a lower relapse rate (rBMT/rPBSCT versus CBT: HR, 2.60; P = .010; uBMT/uPBSCT versus CBT: HR, 2.05; P = .082). This superiority of CBT was more definite in on-disease patients (OS: rBMT/rPBSCT versus CBT: HR, 5.52; P = .021; uBMT/uPBSCT versus CBT: HR, 6.80; P = .007). Better disease control was also strongly associated with better OS and PFS with lower relapse rate. In conclusion, allo-HSCT is beneficial for the survival of patients with mature T and NK cell lymphomas/leukemia if performed in a timely fashion. Since CBT showed favorable survival with a lower relapse risk, it could be a preferred alternative, especially in on-disease patients.

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供体来源对京都干细胞移植组成熟T细胞和自然杀伤细胞肿瘤同种异体造血干细胞移植的影响
尽管同种异体造血干细胞移植(allogeneic hematopoietic stem cell transplantation, alloo - hsct)是治疗成熟T细胞和自然杀伤细胞(NK)淋巴瘤/白血病的关键策略,尤其是那些复发/难治性疾病的患者,但在供体选择方面尚无共识策略。作为一项多机构联合研究项目,我们回顾性分析了日本15家机构111例患者的同种异体造血干细胞移植结果。39例患者接受了亲属供者的骨髓或外周血干细胞移植(rBMT/rPBSCT), 37例接受了非亲属供者的BMT/PBSCT (uBMT/uPBSCT), 35例接受了脐带血移植(CBT)。4年总生存期(OS)和无进展生存期(PFS)分别为42%和34%。复发和非复发死亡率的累计发生率分别为43%和25%。在多变量分析中,CBT显示出与rBMT/rPBSCT相当的OS (rBMT/rPBSCT vs CBT:风险比[HR], 1.63;P = .264),与uBMT/uPBSCT相比,OS更好(HR, 2.99;P = 0.010),复发率呈较低趋势(rBMT/rPBSCT与CBT: HR, 2.60;p = 0.010;uBMT/uPBSCT与CBT: HR, 2.05;p = .082)。CBT的优势在非疾病患者中更为明确(OS: rBMT/rPBSCT vs CBT: HR, 5.52;p = 0.021;uBMT/uPBSCT与CBT: HR, 6.80;p = .007)。更好的疾病控制也与更好的OS和PFS以及更低的复发率密切相关。总之,如果及时进行同种异体造血干细胞移植,对成熟T细胞和NK细胞淋巴瘤/白血病患者的生存是有益的。由于CBT表现出较好的生存率和较低的复发风险,因此它可能是一种首选的替代方案,特别是在未患病的患者中。
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来源期刊
CiteScore
6.60
自引率
0.00%
发文量
1061
审稿时长
3-6 weeks
期刊介绍: Biology of Blood and Marrow Transplantation publishes original research reports, reviews, editorials, commentaries, letters to the editor, and hypotheses and is the official publication of the American Society for Transplantation and Cellular Therapy. The journal focuses on current technology and knowledge in the interdisciplinary field of hematopoetic stem cell transplantation.
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