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Bone marrow haploidentical transplant with post-transplantation cyclophosphamide: does graft cell content have an impact on main clinical outcomes?
Cytotherapy ( IF 4.5 ) Pub Date : 2020-03-01 , DOI: 10.1016/j.jcyt.2020.01.007
Luciana Teofili 1 , Patrizia Chiusolo 1 , Caterina Giovanna Valentini 2 , Elisabetta Metafuni 2 , Silvia Bellesi 2 , Nicoletta Orlando 2 , Maria Bianchi 2 , Sabrina Giammarco 2 , Simona Sica 1 , Andrea Bacigalupo 1
Affiliation  

We analyzed data relative to cell content in 88 consecutive patients receiving HLA haploidentical bone marrow (BM) transplants with post-transplantation cyclophosphamide (PT-CY). Median age was 54.5 (range, 17-72); diagnoses were acute leukemia (n = 46), lymphoproliferative disorders (n = 24), myelofibrosis (n = 11) and myelodysplastic syndromes (n = 5). Total nucleated cell (TNC) and CD34+, CD3+, CD4+ and CD8+ cell doses were stratified as higher than first, second and third quartile and the dose effect on various clinical outcomes was assessed. Median time to engraftment was 17 days for neutrophils and 24 days for platelets. To receive a dose of TNC ≥3.2 x 106/kg or CD34+ cells ≥2.7 x 106/kg significantly shortened the time to neutrophil and platelet engraftment and reduced the blood product requirements in the 30-day period after transplantation. Overall, TNC and CD34+ cell doses had no effect on acute graft-versus-host disease (GVHD) incidence, whereas patients receiving higher CD3+ and CD8+ cell doses seemed to have less chronic GVHD. No effect on non-relapse mortality, progression-free survival and overall survival was observed at different cell dose thresholds. These data suggest that in HLA haploidentical BM transplant with PT-CY, appropriate cell doses are relevant to the engraftment. The association between low CD3+/CD8+ cells and chronic GVHD deserves further investigation.

中文翻译:

移植后环磷酰胺的骨髓单倍体移植:移植细胞含量对主要临床结果有影响吗?

我们分析了 88 名接受 HLA 半相合骨髓 (BM) 移植和移植后环磷酰胺 (PT-CY) 的连续患者的细胞含量数据。中位年龄为 54.5(范围,17-72);诊断为急性白血病(n = 46)、淋巴组织增生性疾病(n = 24)、骨髓纤维化(n = 11)和骨髓增生异常综合征(n = 5)。总有核细胞 (TNC) 和 CD34+、CD3+、CD4+ 和 CD8+ 细胞剂量被分层为高于第一、第二和第三四分位数,并评估了对各种临床结果的剂量效应。中性粒细胞植入的中位时间为 17 天,血小板为 24 天。接受一剂 TNC ≥3.2 x 106/kg 或 CD34+ 细胞≥2。7 x 106/kg 显着缩短了中性粒细胞和血小板植入的时间,并减少了移植后 30 天内的血液制品需求。总体而言,TNC 和 CD34+ 细胞剂量对急性移植物抗宿主病 (GVHD) 发病率没有影响,而接受较高 CD3+ 和 CD8+ 细胞剂量的患者似乎具有较少的慢性 GVHD。在不同的细胞剂量阈值下,未观察到对非复发死亡率、无进展生存期和总生存期的影响。这些数据表明,在具有 PT-CY 的 HLA 半相合 BM 移植中,适当的细胞剂量与移植有关。低 CD3+/CD8+ 细胞与慢性 GVHD 之间的关联值得进一步研究。而接受较高 CD3+ 和 CD8+ 细胞剂量的患者似乎具有较少的慢性 GVHD。在不同的细胞剂量阈值下,未观察到对非复发死亡率、无进展生存期和总生存期的影响。这些数据表明,在具有 PT-CY 的 HLA 半相合 BM 移植中,适当的细胞剂量与移植有关。低 CD3+/CD8+ 细胞与慢性 GVHD 之间的关联值得进一步研究。而接受较高 CD3+ 和 CD8+ 细胞剂量的患者似乎具有较少的慢性 GVHD。在不同的细胞剂量阈值下,未观察到对非复发死亡率、无进展生存期和总生存期的影响。这些数据表明,在具有 PT-CY 的 HLA 半相合 BM 移植中,适当的细胞剂量与移植有关。低 CD3+/CD8+ 细胞与慢性 GVHD 之间的关联值得进一步研究。
更新日期:2020-03-01
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