Searching for unrelated donor hematopoietic stem cells: Availability and speed of umbilical cord blood versus bone marrow
Searching for unrelated donor hematopoietic stem cells: Availability and speed of umbilical cord blood versus bone marrow
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DOI：
10.1053/bbmt.2002.v8.pm12064362
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发表时间：
2002-01-01
影响因子：
4.3
通讯作者：
Weisdorf, DJ
中科院分区：
文献类型：
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作者：
Barker, JN;Krepski, TP;Weisdorf, DJ
非亲缘供者（URD）脐带血（UCB）在造血干细胞移植中比URD BM有几个潜在的优势。为了检查这些URD干细胞来源的供体识别效率，我们回顾了1年内明尼苏达大学所有儿科和成人URD移植转诊的搜索过程。在171例连续转诊的URD移植中，108例患者进行了正式的URD搜索，至少选择了1名供体。对于需要紧急移植的患者，进行UCB检索（54%）比BM检索（21%）明显更正式（P <0.01）。108例患者中有21例（19%）至少有一个4-6/6 HLA抗原匹配的UCB移植物，但没有合适的BM移植物。获得URD骨髓供体所需的中位时间（从正式搜索到骨髓供体的批准）为49天（范围，32-293天），而UCB搜索时间（从正式搜索到选择供体单位）仅为13.5天（范围，2-387天）。对于同时进行骨髓和脐带血检查的患者，需要29天（95%置信区间，21-37天）的时间来识别和清除URD骨髓供体，而不是脐带血供体（P <0.01）。对于76名进行移植的患者，接受UCB的患者比接受BM的患者接受移植的时间平均快25天（P <0.01）。这些数据证实，库存的冷冻保存的URD UCB移植物的可用性允许对没有可用的BM供体的患者进行移植，并且URD UCB移植物的可用性比URD BM移植物快得多。对于需要紧急移植的患者来说，更快的可用性是一个特别的优势。在比较UCB与BM移植受者的结局时，以及在设计比较URD来源的前瞻性试验时，必须考虑UCB移植的这些独特特征。
Unrelated donor (URD) umbilical cord blood (UCB) has several potential advantages over URD BM for hematopoietic stem cell transplantation. To examine the efficiency of donor identification for each of these URD stem cell sources, we reviewed the search processes for all pediatric and adult URD transplantation referrals to the University of Minnesota during a period of 1 year. Of 171 consecutive referrals for URD transplantation, 108 patients proceeded to a formal URD search with selection of at least 1 donor. Significantly more formal UCB searches (54%) than BM searches (21%) were performed for patients who required urgent transplantation (P < .01). At least one 4-6/6 HLA-antigen matched UCB graft but no suitable BM graft was identified for 21 of the 108 patients (19%). The median time required to obtain a URD BM donor (from formal search to clearance of a BM donor) was 49 days (range, 32-293 days) compared to a UCB search time (from formal search to a donor unit chosen) of only 13.5 days (range, 2-387 days). For patients undergoing both BM and UCB searches, 29 more days (95% confidence interval, 21-37 days) were required to identify and clear a URD BM donor than a UCB donor (P < .01). For the 76 patients who proceeded to transplantation, patients receiving UCB received a transplant a median of 25 days more rapidly than did those receiving BM (P < .01). These data confirm that the availability of banked cryopreserved URD UCB grafts allows transplantations for patients with no available BM donor and that URD UCB grafts are available considerably faster than are URD BM grafts. Faster availability is a particular advantage for patients requiring urgent transplantation. These unique features of UCB transplantation must be considered in comparisons of the outcomes of UCB versus BM transplant recipients and in the design of prospective trials comparing URD sources.