Transplantation of unrelated donor umbilical cord blood in 102 patients with malignant and nonmalignant diseases: influence of CD34 cell dose and HLA disparity on treatment-related mortality and survival
Transplantation of unrelated donor umbilical cord blood in 102 patients with malignant and nonmalignant diseases: influence of CD34 cell dose and HLA disparity on treatment-related mortality and survival
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DOI：
10.1182/blood-2002-01-0294
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发表时间：
2002-09-01
期刊：
影响因子：
20.3
通讯作者：
Davies, SM
中科院分区：
文献类型：
--
作者：
Wagner, JE;Barker, JN;Davies, SM
无关供者骨髓移植的潜在益处被移植物抗宿主病（GVHD）和感染的免疫并发症抵消。因此，我们使用冷冻保存的脐带血（UCB）作为降低GVHD和治疗相关死亡率（TRM）的风险并提高生存率的策略。对102例患者（中位年龄7.4岁）的数据进行了评估，这些患者在1994年至2001年期间接受了移植治疗恶性（n = 65; 68%为高危患者）和非恶性（n = 37）疾病。使用对数秩检验和考克斯回归分析来确定各种人口统计学、移植物相关和治疗因素对移植、GVHD、TRM、复发和生存的影响。截至2001年10月15日，中位随访时间为2.7年（范围：0.3-7.2年）。中性粒细胞和血小板植入的发生率分别为0.88（CI，0.81-0.95）和0.65（CI，0.53-0.77）。值得注意的是，严重急性和慢性GVHD的发生率分别为0.11（CI，0.05-0.17）和0.10（CI，0.04-0.16）。移植后1年TRM和生存率分别为0.30（CI，0.21-0.39）和0.58（CI，0.480.68）。在考克斯回归分析中，CD 34细胞剂量是一个始终被确定为与植入率、TRM和存活率显著相关的因素。尽管GVHD的发生率较低，但标准和高危疾病患者2年时白血病复发的患者比例分别为0.17（CI，0.00-0.38）和0.45（CI，0.28-0.61）。当移植物含有至少1.7 × 10（5）CD 34（+）细胞/千克受体体重时，在人类白细胞抗原（HLA）不超过2种的UCB移植物的受体中存活的可能性很高。因此，当存在多个UCB单位且HLA差异为2或更小时，移植物选择应主要基于CD 34细胞剂量。（C）2002，美国血液学会。
The potential benefits of unrelated donor marrow transplantation are offset by the immunologic complications of graft-versus-host disease (GVHD) and infection. Therefore, we used cryopreserved umbilical cord blood (UCB) as a strategy to reduce the risks of GVHD and treatment-related mortality (TRM) and improve survival. Data on 102 patients (median age 7.4 years) who received transplants between 1994 and 2001 for the treatment of malignant (n = 65; 68% were high-risk patients) and nonmalignant (n = 37) diseases were evaluated. Log-rank tests and Cox regression analyses were used to determine the effects of various demographic, graft-related, and treatment factors on engraftment, GVHD, TRM, relapse, and survival. As of October 15, 2001, the median follow-up was 2.7 years (range, 0.3-7.2). Incidences of neutrophil and platelet engraftment were 0.88 (CI, 0.81-0.95) and 0.65 (CI, 0.53-0.77), respectively. Notably, incidences of severe acute and chronic GVHD were 0.11 (CI, 0.05-0.17) and 0.10 (CI, 0.04-0.16), respectively. At 1 year after transplantation, proportions of TRM and survival were 0.30 (CI, 0.21-0.39) and 0.58 (CI, 0.480.68), respectively. In Cox regression analyses, CD34 cell dose was the one factor consistently identified as significantly associated with rate of engraftment, TRM, and survival. Despite the low incidence of GVHD, the proportion of patients with leukemia relapse at 2 years was 0.17 (CI, 0.00-0.38) and 0.45 (CI, 0.28-0.61) for patients with standard and high-risk disease, respectively. There is a high probability of survival in recipients of UCB grafts that are disparate in no more than 2 human leukocyte antigens (HLAs) when the grafts contain at least 1.7 x 10(5) CD34(+) cells per kilogram of recipient's body weight. Therefore, graft selection should be based principally on CD34 cell dose when multiple UCB units exist with an HLA disparity of 2 or less. (C) 2002 by The American Society of Hematology.