针对高风险白血病或MDS患者的偶同性HCT前的向辐射输送产生了长期幸存者
Johnnie J Orozco1,2, Phuong T Vo1,2, Ted A Gooley1,3
1Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
概括
这项研究表明,在平分异性造血细胞移植 (HCT) 之前的131I-anti-CD45放射性免疫疗法是复发性/耐药性急性髓性白血病 (AML) 和其他高风险髓性恶性瘤患者的可行和潜在的治疗方法.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 免疫治疗是一种免疫疗法.
背景情况:
- 造血细胞移植 (HCT) 提供了神经髓质恶性瘤的治疗潜力.
- 许多患者无法忍受骨髓损伤性条件,需要采用替代方法.
- 高风险的复发性/耐药性急性髓性白血病 (AML),急性淋巴性白血病 (ALL) 和骨髓质综合征 (MDS) 存在重大治疗挑战.
研究的目的:
- 评估一期/二期研究的长期结果,该研究将131I-anti-CD45抗体BC8与非骨髓缩条件结合起来.
- 评估这种方法在HLA-haploidentical HCT在患有高风险血液恶性瘤的成年人之前的可行性和有效性.
- 确定这种新型放射性免疫疗法方案的安全性和生存终点.
主要方法:
- 患者接受了131I-anti-CD45 (12-26 Gy) 的升级剂量,随后进行了fludarabine,环胺 (CY) 和2 Gy全身辐射 (TBI) 调节.
- 进行了HLA-haploidentical骨髓HCT,并进行了GVHD预防,包括移植后CY,tacrolimus和mycophenolate mofetil.
- 该研究包括25名患有AML,ALL或高风险MDS的患者,包括那些耐药性疾病或先前HCT衰竭的患者.
主要成果:
- 所有25名患者在HCT后28天实现了形态缓解;仅在2名患者中观察到最小的残留疾病.
- 中等移植时间为中性粒细胞15天,血小板23天.
- 一年生存率和无进展生存率估计分别为40%和32%,两年生存率为24%. 一年复发和非复发死亡率分别为56%和12%.
结论:
- 131I-anti-45放射性免疫疗法是一个可行的条件调节方案,可以在单双相同的HCT之前进行.
- 这种方法可以在某些患有高风险髓状瘤的患者中实现治愈结果.
- 组合疗法表现出可接受的毒性,为那些无法接受标准骨髓损伤条件的患者提供了潜在的治疗选择.
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