当院における移植後シクロホスファミドを用いたHLA 半合致移植の経験

移植後シクロフォスファミド(posttransplant cyclophosphamide, PTCy)による移植片対宿主病(graft-versus-host disease, GVHD)予防法の登場により、HLA 半合致移植は現在世界で拡大を続けている。本研究では49 名の血液悪性腫瘍の患者(年齢中央値:57 歳)にPTCy を用いたHLA 半合致移植を施行し、その治療成績、安全性を後方視的に検討した。2 年全生存率 74.8%、2 年無増悪生存期間 66.3 %、2 年無GVHD/ 再発生存率 44.1%、1 年非再発死亡率 4.1%、Ⅱ - Ⅳ度1 年急性GVHD 34.5%、2 年慢...

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Published in神戸市立病院紀要 Vol. 60; pp. 9 - 15
Main Authors 井本, 寛東, 岡田, 直樹, 米谷, 昇, 山本, 隆介, 吉岡, 聡, 松下, 章子, 下村, 良充, 上條, 公守, 石川, 隆之, 西久保, 雅司, 平本, 展大
Format Journal Article
LanguageJapanese
Published 地方独立行政法人 神戸市民病院機構 2022
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ISSN0286-455X
2434-7590
DOI10.32301/kobecityhospital.60.0_9

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Abstract 移植後シクロフォスファミド(posttransplant cyclophosphamide, PTCy)による移植片対宿主病(graft-versus-host disease, GVHD)予防法の登場により、HLA 半合致移植は現在世界で拡大を続けている。本研究では49 名の血液悪性腫瘍の患者(年齢中央値:57 歳)にPTCy を用いたHLA 半合致移植を施行し、その治療成績、安全性を後方視的に検討した。2 年全生存率 74.8%、2 年無増悪生存期間 66.3 %、2 年無GVHD/ 再発生存率 44.1%、1 年非再発死亡率 4.1%、Ⅱ - Ⅳ度1 年急性GVHD 34.5%、2 年慢性GVHD 40.5% であり、一定の治療効果を認めつつ、安全性に優れていた。PTCy を用いたHLA 半合致移植は本邦で安全に施行できる移植方法の一つであると考えられた。
AbstractList 移植後シクロフォスファミド(posttransplant cyclophosphamide, PTCy)による移植片対宿主病(graft-versus-host disease, GVHD)予防法の登場により、HLA 半合致移植は現在世界で拡大を続けている。本研究では49 名の血液悪性腫瘍の患者(年齢中央値:57 歳)にPTCy を用いたHLA 半合致移植を施行し、その治療成績、安全性を後方視的に検討した。2 年全生存率 74.8%、2 年無増悪生存期間 66.3 %、2 年無GVHD/ 再発生存率 44.1%、1 年非再発死亡率 4.1%、Ⅱ - Ⅳ度1 年急性GVHD 34.5%、2 年慢性GVHD 40.5% であり、一定の治療効果を認めつつ、安全性に優れていた。PTCy を用いたHLA 半合致移植は本邦で安全に施行できる移植方法の一つであると考えられた。
Author 西久保, 雅司
山本, 隆介
井本, 寛東
上條, 公守
岡田, 直樹
松下, 章子
下村, 良充
吉岡, 聡
石川, 隆之
平本, 展大
米谷, 昇
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References Sugita J, Kawashima N,Fujisaki T,et al:HLA-Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplant Cyclophosphamide after Busulfan-Containing Reduced-Intensity Conditioning. Biol. Blood Marrow Transplant. 21(9):1646-1652, 2015
Nakamae H, Koh H, Katayama T, et al: HLA haploidentical peripheral blood stem cell transplantation using reduced dose of posttransplantation cyclophosphamide for poor-prognosis or refractory leukemia and myelodysplastic syndrome. Exp. Hematol. 43(11):921-929.e1,2015
McCurdy SR, Luznik L: How we perform haploidentical stem cell transplantation with posttransplant cyclophosphamide. Blood. 134(21):1802-1810, 2019
Eastburg L, Russler-Germain DA, Abboud R,et al: Increased Early Mortality after Fludarabine and Melphalan Conditioning with Peripheral Blood Grafts in Haploidentical SCT with Post-Transplant Cyclophosphamide. Blood 134(Supplement_1):4496,2019
Gragert L,Eapen M,Williams E,et al: HLA Match Likelihoods for Hematopoietic Stem-Cell Grafts in the U.S. Registry. N. Engl. J. Med. 371(4) :339-348,2014
Filipovich AH,Weisdorf D, Pavletic S,et al:National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Report. Biol. Blood Marrow Transplant. 11(12):945-956,2005
Gooptu M, Romee R, St. Martin A, et al:HLA-haploidentical vs matched unrelated donor transplants with posttransplant cyclophosphamide-based prophylaxis. Blood. 138(3) :273-282, 2021
El Fakih R, Hashmi SK, Ciurea SO,et al:Post-transplant cyclophosphamide use inmatched HLA donors: a review of literature and future application. Bone Marrow Transplant. 55(1):40-47,2020
Glucksberg H, R Storb, A Fefer, et al: Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 18:295-304,1974
Solh MM,Hinojosa G, Laporte J, et al: A Phase II Trial of Melphalan Based Reduced-Intensity Conditioning for Transplantation of T-Replete HLA-Haploidentical Peripheral Blood Stem Cells with Posttransplant Cyclophosphamide in Patients with Hematologic Malignancies. Adv. Hematol.2021:1-6,2021
Sugita J, Kamimura T, Ishikawa T, et al: Reduced dose of posttransplant cyclophosphamide in HLA-haploidentical peripheral blood stem cell transplantation. Bone Marrow Transplant. 56(3):596-604, 2021
Holtan SG, DeFor TE, Lazaryan A, et al:Composite end point of graft-versus-host disease-free, relapse-free survival after allogeneic hematopoietic cell transplantation. Blood. 125(8):1333-1338,2015
Luznik L, O’Donnell PV, Symons HJ, et al:HLA-Haploidentical Bone Marrow Transplantation for Hematologic Malignancies Using Nonmyeloablative Conditioning and High-Dose, Posttransplantation Cyclophosphamide. Biol. Blood Marrow Transplant. 14(6):641-650,2008
Goldsmith SR, Slade M, DiPersio JF,et al:Cytomegalovirus viremia, disease, and impacton relapse in T-cell replete peripheral blood haploidentical hematopoietic cell transplantationwith post-transplant cyclophosphamide. Haematologica. 101(11):e465–e468,2016
Marty FM, Ljungman P, Chemaly RF, et al:Letermovir Prophylaxis for Cytomegalovirus inHematopoietic-Cell Transplantation. N. Engl. J. Med. 377(25):2433-2444,2017
Sugita J, Kagaya Y,Miyamoto T, et al: Myeloablative and reduced-intensity conditioning in HLA-haploidentical peripheral blood stem cell transplantation using post-transplant cyclophosphamide. Bone Marrow Transplant. 54(3):432-441, 2019
Armand P, Kim HT, Logan BR, et al: Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood. 123(23):3664-3671,2014
Fuchs EJ: Haploidentical transplantation for hematologic malignancies: where do we stand?Hematology Am Soc Hematol Educ Program. 2012:230-236, 2012
O'Donnell PV, Luznik L, Jones RJ, et al:Nonmyeloablative bone marrow transplantationfrom partially HLA-mismatched related donors using posttransplantation cyclophosphamide.Biol. Blood Marrow Transplant. 8(7):377-386,2002
Robinson TM,O’Donnell PV, Fuchs EJ,et al: Haploidentical bone marrow and stem celltransplantation: experience with post-transplantation cyclophosphamide. Semin. Hematol. 53(2):90-97,2016
References_xml – reference: Eastburg L, Russler-Germain DA, Abboud R,et al: Increased Early Mortality after Fludarabine and Melphalan Conditioning with Peripheral Blood Grafts in Haploidentical SCT with Post-Transplant Cyclophosphamide. Blood 134(Supplement_1):4496,2019
– reference: Holtan SG, DeFor TE, Lazaryan A, et al:Composite end point of graft-versus-host disease-free, relapse-free survival after allogeneic hematopoietic cell transplantation. Blood. 125(8):1333-1338,2015
– reference: El Fakih R, Hashmi SK, Ciurea SO,et al:Post-transplant cyclophosphamide use inmatched HLA donors: a review of literature and future application. Bone Marrow Transplant. 55(1):40-47,2020
– reference: Marty FM, Ljungman P, Chemaly RF, et al:Letermovir Prophylaxis for Cytomegalovirus inHematopoietic-Cell Transplantation. N. Engl. J. Med. 377(25):2433-2444,2017
– reference: Luznik L, O’Donnell PV, Symons HJ, et al:HLA-Haploidentical Bone Marrow Transplantation for Hematologic Malignancies Using Nonmyeloablative Conditioning and High-Dose, Posttransplantation Cyclophosphamide. Biol. Blood Marrow Transplant. 14(6):641-650,2008
– reference: Glucksberg H, R Storb, A Fefer, et al: Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 18:295-304,1974
– reference: Filipovich AH,Weisdorf D, Pavletic S,et al:National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. Diagnosis and Staging Working Group Report. Biol. Blood Marrow Transplant. 11(12):945-956,2005
– reference: Armand P, Kim HT, Logan BR, et al: Validation and refinement of the Disease Risk Index for allogeneic stem cell transplantation. Blood. 123(23):3664-3671,2014
– reference: Sugita J, Kawashima N,Fujisaki T,et al:HLA-Haploidentical Peripheral Blood Stem Cell Transplantation with Post-Transplant Cyclophosphamide after Busulfan-Containing Reduced-Intensity Conditioning. Biol. Blood Marrow Transplant. 21(9):1646-1652, 2015
– reference: Gooptu M, Romee R, St. Martin A, et al:HLA-haploidentical vs matched unrelated donor transplants with posttransplant cyclophosphamide-based prophylaxis. Blood. 138(3) :273-282, 2021
– reference: Robinson TM,O’Donnell PV, Fuchs EJ,et al: Haploidentical bone marrow and stem celltransplantation: experience with post-transplantation cyclophosphamide. Semin. Hematol. 53(2):90-97,2016
– reference: Sugita J, Kamimura T, Ishikawa T, et al: Reduced dose of posttransplant cyclophosphamide in HLA-haploidentical peripheral blood stem cell transplantation. Bone Marrow Transplant. 56(3):596-604, 2021
– reference: Goldsmith SR, Slade M, DiPersio JF,et al:Cytomegalovirus viremia, disease, and impacton relapse in T-cell replete peripheral blood haploidentical hematopoietic cell transplantationwith post-transplant cyclophosphamide. Haematologica. 101(11):e465–e468,2016
– reference: O'Donnell PV, Luznik L, Jones RJ, et al:Nonmyeloablative bone marrow transplantationfrom partially HLA-mismatched related donors using posttransplantation cyclophosphamide.Biol. Blood Marrow Transplant. 8(7):377-386,2002
– reference: Gragert L,Eapen M,Williams E,et al: HLA Match Likelihoods for Hematopoietic Stem-Cell Grafts in the U.S. Registry. N. Engl. J. Med. 371(4) :339-348,2014
– reference: McCurdy SR, Luznik L: How we perform haploidentical stem cell transplantation with posttransplant cyclophosphamide. Blood. 134(21):1802-1810, 2019
– reference: Sugita J, Kagaya Y,Miyamoto T, et al: Myeloablative and reduced-intensity conditioning in HLA-haploidentical peripheral blood stem cell transplantation using post-transplant cyclophosphamide. Bone Marrow Transplant. 54(3):432-441, 2019
– reference: Fuchs EJ: Haploidentical transplantation for hematologic malignancies: where do we stand?Hematology Am Soc Hematol Educ Program. 2012:230-236, 2012
– reference: Nakamae H, Koh H, Katayama T, et al: HLA haploidentical peripheral blood stem cell transplantation using reduced dose of posttransplantation cyclophosphamide for poor-prognosis or refractory leukemia and myelodysplastic syndrome. Exp. Hematol. 43(11):921-929.e1,2015
– reference: Solh MM,Hinojosa G, Laporte J, et al: A Phase II Trial of Melphalan Based Reduced-Intensity Conditioning for Transplantation of T-Replete HLA-Haploidentical Peripheral Blood Stem Cells with Posttransplant Cyclophosphamide in Patients with Hematologic Malignancies. Adv. Hematol.2021:1-6,2021
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Snippet 移植後シクロフォスファミド(posttransplant cyclophosphamide, PTCy)による移植片対宿主病(graft-versus-host disease, GVHD)予防法の登場により、HLA 半合致移植は現在世界で拡大を続けている。本研究では49 名の血液悪性腫瘍の患者(年齢中央値:57...
SourceID jstage
SourceType Publisher
StartPage 9
SubjectTerms GVHD 予防
HLA 半合致移植
同種造血幹細胞移植
移植後シクロホスファミド
Title 当院における移植後シクロホスファミドを用いたHLA 半合致移植の経験
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Volume 60
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