Ghép tế bào huyết học đồng loại sau khi điều trị bằng kháng thể 131I–anti-CD45 kết hợp với fludarabine và chiếu xạ toàn thân liều thấp cho bệnh nhân cao tuổi mắc bệnh bạch cầu myeloid cấp tiến triển hoặc hội chứng myelodysplastic nguy cơ cao

Blood - Tập 114 - Trang 5444-5453 - 2009
John M. Pagel1,2, Theodore A. Gooley1, Joseph Rajendran3, Darrell R. Fisher4, Wendy A. Wilson1, Brenda M. Sandmaier1,2, Dana C. Matthews1,5, H. Joachim Deeg1,2, Ajay K. Gopal1,2, Paul J. Martin1,2, Rainer F. Storb1,2, Oliver W. Press1,2, Frederick R. Appelbaum1,2
1Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA
2Departments of Medicine
3Nuclear Medicine, University of Washington, Seattle
4Pacific Northwest National Laboratory, Richland, WA
5Department of Pediatrics, University of Washington, Seattle;

Tóm tắt

Tóm tắt

Chúng tôi đã tiến hành một nghiên cứu để ước lượng liều tối đa có thể dung nạp (MTD) của kháng thể 131I–anti-CD45 (Ab; BC8) có thể kết hợp với chế độ điều trị giảm cường độ chuẩn trước khi ghép tế bào huyết học đồng loại. Năm mươi tám bệnh nhân trên 50 tuổi mắc bệnh bạch cầu myeloid cấp tiến triển (AML) hoặc hội chứng myelodysplastic nguy cơ cao (MDS) đã được điều trị bằng kháng thể 131I-BC8 và fludarabine kết hợp với chiếu xạ toàn thân 2 Gy. Tám mươi sáu phần trăm bệnh nhân có AML hoặc MDS với hơn 5% tế bào bào tủy tại thời điểm ghép. Phác đồ điều trị đã tạo ra sự thuyên giảm hoàn toàn ở tất cả bệnh nhân, và tất cả đều có tế bào CD3+ và CD33+ nguồn gốc từ người cho chiếm 100% trong máu vào ngày thứ 28 sau ghép. MTD của kháng thể 131I-BC8 được cung cấp cho gan được ước lượng là 24 Gy. Bảy bệnh nhân (12%) đã chết vì các nguyên nhân không tái phát đến ngày thứ 100. Xác suất ước tính của khối u tái phát trong 1 năm là 40%, và tỷ lệ sống 1 năm ước tính là 41%. Những kết quả này cho thấy liệu pháp xạ trị nhắm đến CD45 có thể được kết hợp an toàn với chế độ điều trị giảm cường độ để mang lại tỷ lệ sống sót toàn bộ khả quan cho những bệnh nhân cao tuổi có nguy cơ cao mắc AML hoặc MDS. Nghiên cứu này đã được đăng ký tại www.clinicaltrials.gov với mã #NCT00008177.

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