内容紹介
Transplant-Related Mortality Following Allogeneic Hematopoietic Stem Cell Transplantation Using Fludarabine/Busulfan-Based Reduced-Intensity Conditioning―A Retrospective Analysis in a Single Institution
Summury
Reduced-intensity conditioning(RIC)has been shown to facilitate allogeneic hematopoietic stem cell transplantation(allo-HSCT)for patients with comorbidities and the elderly. However, there are some concerns about transplant-related mortality(TRM). We retrospectively analyzed 37 consecutive patients who received allo-HSCT using RIC from January 2005 to December 2012 in our hospital. All patients received fludarabine(FLU), 180 mg/m2, and intravenous busulfan(BU), 6.4 mg/kg(or oral BU 8 mg/kg), with or without TBI(2 or 4 Gy). Cyclosporine or tacrolimus alone, or in combination with short-term methotrexate therapy was used for GVHD prophylaxis. Donor sources included related peripheral blood donors(n=4), and related(n=8)and unrelated(n=25)bone marrow donors. The underlying diseases were various, and 27 patients were considered to be at standard risk. Although one patient died of early disease progression, engraftment was achieved for the others. With a median follow-up of 28.5 months, the estimated 1-year and 5-year TRMs were 13% and 20%, respectively. Five patients died of transplant-related complications, which consisted of 2 cases of acute GVHD and 1 case each of interstitial pneumonitis, bronchiolitis obliterans, and infectious pneumonia. In conclusion, FLU/BU-based RIC is tolerable, but further optimization is needed to prevent transplant-related complications.
要旨
骨髄非破壊的前処置(RIC)により同種造血幹細胞移植は,合併症をもつ患者や高齢者においても治癒を期待し得る手段の一つとなったが,一定の移植関連死亡や再発が生じ得る。2005年1月～2012年12月に当院で施行したRICを用いた同種造血幹細胞移植37例を後方視的に解析した。全例がfludarabine(FLU)180 mg/m2,busulfan(BU)静注6.4 mg/kgまたは内服8 mg/kgと全身放射線照射(TBI)(0～4 Gy)の前処置で,graft-versus-host disease(GVHD)予防はcyclosporine/tacrolimusと短期methotrexateを用いた。ドナーは血縁末【梢】血4例,血縁骨髄8例,非血縁骨髄25例。基礎疾患は様々で,27例が標準リスクであった。day 7で腫瘍死した1例を除き,全例が生着した。観察期間中央値は28.5か月で,1年・5年の移植関連死亡率は13%・20%であった。移植関連死5例中,急性GVHD 2例,間質性肺炎・閉塞性気管支炎・肺炎を1例ずつに認めた。FLU/BUによるRICは,生着や移植関連死亡率から考えると安全に実施し得るが,移植後合併症の低下に向け改善の余地がある。
目次
Summury
Reduced-intensity conditioning(RIC)has been shown to facilitate allogeneic hematopoietic stem cell transplantation(allo-HSCT)for patients with comorbidities and the elderly. However, there are some concerns about transplant-related mortality(TRM). We retrospectively analyzed 37 consecutive patients who received allo-HSCT using RIC from January 2005 to December 2012 in our hospital. All patients received fludarabine(FLU), 180 mg/m2, and intravenous busulfan(BU), 6.4 mg/kg(or oral BU 8 mg/kg), with or without TBI(2 or 4 Gy). Cyclosporine or tacrolimus alone, or in combination with short-term methotrexate therapy was used for GVHD prophylaxis. Donor sources included related peripheral blood donors(n=4), and related(n=8)and unrelated(n=25)bone marrow donors. The underlying diseases were various, and 27 patients were considered to be at standard risk. Although one patient died of early disease progression, engraftment was achieved for the others. With a median follow-up of 28.5 months, the estimated 1-year and 5-year TRMs were 13% and 20%, respectively. Five patients died of transplant-related complications, which consisted of 2 cases of acute GVHD and 1 case each of interstitial pneumonitis, bronchiolitis obliterans, and infectious pneumonia. In conclusion, FLU/BU-based RIC is tolerable, but further optimization is needed to prevent transplant-related complications.
要旨
骨髄非破壊的前処置(RIC)により同種造血幹細胞移植は,合併症をもつ患者や高齢者においても治癒を期待し得る手段の一つとなったが,一定の移植関連死亡や再発が生じ得る。2005年1月～2012年12月に当院で施行したRICを用いた同種造血幹細胞移植37例を後方視的に解析した。全例がfludarabine(FLU)180 mg/m2,busulfan(BU)静注6.4 mg/kgまたは内服8 mg/kgと全身放射線照射(TBI)(0～4 Gy)の前処置で,graft-versus-host disease(GVHD)予防はcyclosporine/tacrolimusと短期methotrexateを用いた。ドナーは血縁末【梢】血4例,血縁骨髄8例,非血縁骨髄25例。基礎疾患は様々で,27例が標準リスクであった。day 7で腫瘍死した1例を除き,全例が生着した。観察期間中央値は28.5か月で,1年・5年の移植関連死亡率は13%・20%であった。移植関連死5例中,急性GVHD 2例,間質性肺炎・閉塞性気管支炎・肺炎を1例ずつに認めた。FLU/BUによるRICは,生着や移植関連死亡率から考えると安全に実施し得るが,移植後合併症の低下に向け改善の余地がある。