文章：

使用抢先供者淋巴细胞输注策略的急性白血病/骨髓增生异常综合征混合T细胞谱系嵌合状态——是否具有预后意义？——单中心回顾性研究

Mixed T cell lineage chimerism in acute leukemia/MDS using pre-emptive donor lymphocyte infusion strategy—Is it prognostic?—a single-center retrospective study

原文发布日期：2021-07-12

DOI: 10.1038/s41408-021-00519-y

类型: Article

开放获取: 是

英文摘要：

Pre-emptive DLI (pDLI) is an effective strategy in lowering the risk of relapse without significantly increasing the risk of graft-versus-host disease (GVHD) in the case of T cell lineage mixed chimerism (MC) post allogeneic transplant in hematological malignancies. Many patients, however, fail to receive timely pDLI and have dismal outcomes, which are not taken into consideration. We compared long-term outcomes of 106 patients having T cell MC after day 60 and undergoing allogeneic stem cell allograft for acute leukemia from an unrelated donor (UD), with 111 patients having complete chimerism (CC). Fifty-three (56%) patients received prophylactic pDLI. Thirty-six patients (67%) had a response (RR), 17 (33%) had no response (NR), and fifty-two (54%) did not receive any pDLI (ND). OS was better in MC group as compared to CC (54% vs 43%, p = 0.04), mainly due to reduction in NRM (14% vs 25%, p = 0.05), and all grade acute and chronic GVHD. Within the MC group, response to pDLI was the only significant factor predicting OS, DFS, and relapses with NR and ND having unfavorable outcomes as compared to RR (p = 0.001). T cell MC in patients undergoing UD allografts with alemtuzumab is no longer an adverse prognostic factor, as compared to patients having CC, after timely implementation of pDLI.
 

摘要翻译： 

在血液恶性肿瘤异基因移植后出现T细胞谱系混合嵌合状态（MC）的情况下，抢先供者淋巴细胞输注（pDLI）是一种有效策略，可在不明显增加移植物抗宿主病（GVHD）风险的同时降低复发风险。然而，许多患者未能及时接受pDLI且预后不良，这一现象尚未得到充分考量。本研究比较了106例在移植后第60天出现T细胞MC并接受无关供者（UD）异基因干细胞移植的急性白血病患者，与111例完全嵌合（CC）患者的长期结局。其中53例（56%）MC患者接受了预防性pDLI治疗：36例（67%）出现治疗反应（RR），17例（33%）无反应（NR）；另有52例（54%）未接受任何pDLI（ND）。结果显示，MC组总生存率（OS）优于CC组（54%对比43%，p=0.04），主要得益于非复发死亡率（NRM）的降低（14%对比25%，p=0.05）及各等级急慢性GVHD发生率的减少。在MC组内，对pDLI的治疗反应是预测OS、无病生存期（DFS）及复发率的唯一显著因素，NR与ND患者的预后均劣于RR组（p=0.001）。研究证实，对于接受阿仑单抗（alemtuzumab）预处理方案进行无关供者异基因移植的患者，若能及时实施pDLI，T细胞MC状态相较于完全嵌合患者已不再构成不良预后因素。

原文链接：

Mixed T cell lineage chimerism in acute leukemia/MDS using pre-emptive donor lymphocyte infusion strategy—Is it prognostic?—a single-center retrospective study