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Impact of conditioning regimen on peripheral blood hematopoietic cell transplant

World Journal of Clinical Oncology 2019年第2期10卷 86-97页

作者： Michael Burns Anurag K Singh Carrie C Hoefer Yali Zhang Paul K Wallace George L Chen alexis platek Timothy B Winslow Austin J Iovoli Christopher Choi Maureen Ross Philip L McCarthy Theresa Hahn Department of Medicine Roswell Park Comprehensive Cancer Center Department of Radiation Medicine Roswell Park Comprehensive Cancer Center Department of Flow Cytometry Roswell Park Comprehensive Cancer Center Center for Immunotherapy Roswell Park Comprehensive Cancer Center

AIM To investigate infused hematopoietic cell doses and their interaction with conditioning regimen intensity +/-total body irradiation(TBI) on outcomes after peripheral blood hematopoietic cell transplant(PBHCT).METHODS Our retrospective cohort included 247 patients receiving a first, T-replete, human leukocyte antigen-matched allogeneic PBHCT and treated between 2001 and2012. Correlations were calculated using the Pearson product-moment correlation coefficient. Overall survival and progression free survival curves were generated using the Kaplan-Meier method and compared using the log-rank *** Neutrophil engraftment was significantly faster after reduced intensity TBI based conditioning [reduced intensity conditioning(RIC) + TBI] and > 4 × 10~6 CD34+cells/kg infused. A higher total nucleated cell dose led to a higher incidence of grade II-IV acute graft-versus-host disease in the myeloablative + TBI regimen group(P = 0.03), but no significant difference in grade III-IV graft-versus-host disease. A higher total nucleated cell dose was also associated with increased incidence of moderate/severe chronic graft-versus-host disease, regardless ofconditioning regimen. Overall and progression-free survival were significantly better in patients with a RIC + TBI regimen and total nucleated cell dose > 8 ×10~8/kg(3 years, overall survival: 70% vs 38%, P = 0.02, 3 years, progression free survival: 64% vs 38%, P = 0.02).CONCLUSION TBI and conditioning intensity may alter the relationship between infused cell doses and outcomes after PBHCT. Immune cell subsets may predict improved survival after unmanipulated PBHCT.

关键词： Total body radiation Peripheral blood hematopoietic cell transplant Total nucleated dose Neutrophil engraftment Graft-versus-host-disease

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