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Alternative donors provide comparable results to matched unrelated donors in patients with acute lymphoblastic leukemia undergoing allogeneic stem cell transplantation in second complete remission: a report from the EBMT Acute Leukemia Working Party.
Bone Marrow Transplantation ( IF 4.8 ) Pub Date : 2020-03-17 , DOI: 10.1038/s41409-020-0849-x
Eolia Brissot 1, 2 , Myriam Labopin 1, 2 , Domenico Russo 3 , Sonja Martin 4 , Christoph Schmid 5 , Bertram Glass 6 , Ron Ram 7 , Zubeyde Nur Ozkurt 8 , Jakob Passweg 9 , Joan Hendrik Veelken 10 , Donald Bunjes 11 , Jane Apperley 12 , Sebastian Giebel 13 , Mohamad Mohty 1, 2 , Arnon Nagler 2, 14
Affiliation  

Relapse of acute lymphoblastic leukemia (ALL) remains a major therapeutic challenge. Despite the consensus for proceeding to allogeneic stem cell transplantation (HSCT) in relapsing patients with ALL who achieve second complete remission (CR2) with salvage therapy, most patients lack a suitable matched-related histocompatible donor. The present multicenter retrospective study compared, for ALL patients in CR2, the HSCT outcome from all four possible alternative hematopoietic stem cell sources, namely matched unrelated 10/10 (n = 281), mismatched unrelated 9/10 (n = 125), haploidentical (n = 105), and cord blood (n = 104) donors. The 2-year outcomes were not statistically different between the four donor sources with respect to overall survival (38.3–47.2%), leukemia-free survival (30.5–39.6%), relapse incidence (32.6–37.6%), nonrelapse mortality (27.5–34.6%), and graft-versus-host disease-free relapse survival (21.4–33.1%). Donor choices for ALL patients achieving CR2 post first relapse are broad, ensuring that most patient in need secures a graft. Therefore, in practice, the donor choice should depend on timely availability and policy center.



中文翻译:

在第二次完全缓解期接受异基因干细胞移植的急性淋巴细胞白血病患者中,替代供体提供与匹配的无关供体相当的结果:EBMT 急性白血病工作组的报告。

急性淋巴细胞白血病 (ALL) 的复发仍然是一个主要的治疗挑战。尽管对于通过抢救治疗达到第二次完全缓解 (CR2) 的复发性 ALL 患者进行同种异体干细胞移植 (HSCT) 达成共识,但大多数患者缺乏合适的匹配相关组织相容性供体。目前的多中心回顾性研究比较了 CR2 的 ALL 患者,来自所有四种可能的替代造血干细胞来源的 HSCT 结果,即匹配无关 10/10 ( n  = 281)、不匹配不相关 9/10 ( n  = 125)、半相合( n  = 105) 和脐带血 ( n = 104) 捐助者。四种供体来源的 2 年结果在总生存率(38.3-47.2%)、无白血病生存率(30.5-39.6%)、复发率(32.6-37.6%)、非复发死亡率(27.5%)方面没有统计学差异–34.6%)和移植物抗宿主病无复发存活率(21.4–33.1%)。首次复发后达到 CR2 的所有患者的供体选择范围很广,可确保大多数有需要的患者获得移植物。因此,在实践中,捐助者的选择应取决于及时的可用性和政策中心。

更新日期:2020-04-24
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