Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia
Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia
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DOI：
10.1056/nejmoa041276
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发表时间：
2004-11-25
影响因子：
158.5
通讯作者：
Horowitz, MM
中科院分区：
文献类型：
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作者：
Laughlin, MJ;Eapen, M;Horowitz, MM
尽管成人脐带血移植的应用越来越广泛，但有关成人脐带血移植结果的数据却很少。方法我们比较了接受一种HLA抗原不匹配的脐带血的成人白血病患者的无关供体造血干细胞移植结果（34名患者）或两种抗原（116名患者）、具有一种HLA错配的骨髓（83名患者）和HLA匹配的骨髓（367名患者）。我们用考克斯比例风险模型分析数据，结果发现，与骨髓移植受者相比，造血干细胞移植受者更年轻，更容易患晚期白血病，而且他们接受的有核细胞剂量更低。移植不匹配的骨髓和脐带血的造血恢复比匹配的骨髓移植慢。急性移植物抗宿主病（GVHD）更容易发生在不匹配的骨髓移植后，慢性GVHD更容易发生在脐带血移植后。在接受匹配骨髓移植的患者中，治疗相关死亡率、治疗失败率和总死亡率最低。接受不匹配骨髓移植的患者和接受不匹配脐带血移植的患者的治疗相关死亡率（P = 0.96）、治疗失败率（P = 0.69）和总死亡率（P = 0.62）相似。各组白血病复发率无差异。有一个HLA不匹配的患者和那些有两个HLA mismatchs.CONCLUSIONHLA不匹配的脐带血移植后的结果没有差异应被认为是一个可接受的来源的造血干细胞移植的成人在没有一个HLA匹配的成人供体。
BACKGROUNDData regarding the outcome of cord-blood transplantation in adults are scant, despite the fact that these grafts are increasingly used in adults.METHODSWe compared the outcomes of the transplantation of hematopoietic stem cells from unrelated donors in adults with leukemia who had received cord blood that was mismatched for one HLA antigen ( 34 patients) or two antigens ( 116 patients), bone marrow that had one HLA mismatch ( 83 patients), and HLA-matched bone marrow ( 367 patients). We used Cox proportional-hazards models to analyze the data.RESULTSCord-blood recipients were younger and more likely to have advanced leukemia than were bone marrow recipients, and they received lower doses of nucleated cells. Hematopoietic recovery was slower with transplantation of mismatched bone marrow and cord blood than with matched marrow transplantations. Acute graft-versus-host disease (GVHD) was more likely to occur after mismatched marrow transplantation, and chronic GVHD was more likely to occur after cord-blood transplantation. The rates of treatment-related mortality, treatment failure, and overall mortality were lowest among patients who received matched marrow transplants. Patients who received mismatched bone marrow transplants and those who received mismatched cord-blood transplants had similar rates of treatment-related mortality (P = 0.96), treatment failure (P = 0.69), and overall mortality (P = 0.62). There were no differences in the rate of recurrence of leukemia among the groups. There were no differences in outcome after cord-blood transplantation between patients with one HLA mismatch and those with two HLA mismatches.CONCLUSIONSHLA-mismatched cord blood should be considered an acceptable source of hematopoietic stem-cell grafts for adults in the absence of an HLA-matched adult donor.