Serious infections after unrelated donor transplantation in 136 children: Impact of stem cell source
Serious infections after unrelated donor transplantation in 136 children: Impact of stem cell source
复制标题
DOI：
10.1016/j.bbmt.2005.02.004
复制
发表时间：
2005-05-01
影响因子：
4.3
通讯作者：
Wagner, JE
中科院分区：
文献类型：
--
作者：
Barker, JN;Hough, RE;Wagner, JE
脐带血（UCB）和骨髓（BM）移植后的感染风险如何比较尚不清楚。因此，我们比较了小儿清髓性无关供体移植后2年内严重感染与未经处理的BM（n = 52），T细胞去除（TCD）BM（n = 24），或UCB（n = 60）治疗血液系统恶性肿瘤。总体而言，两组间1例或1例以上严重感染的累积发生率相当（BM，81%; TCD，83%; UCB，90%; P = 0.12）。此外，通过考虑所有严重感染并使用多变量技术，以未处理的BM作为参考，两组之间也没有显著差异（TCD相对风险[RR]，1.6; P = 0.10; UCB RR，1.0; P = 0.84）。在0 - 42天、43 - 100天和101 - 180天的时间段内，唯一的差异是TCD接受者从0 - 42天的病毒感染风险更高（RR，3.5; P = 0.02）。值得注意的是，180天后，TCD接受者的感染风险显著增加（RR，3.1; P = .03），而UCB接受者的风险（RR，0.5; P = .23）与BM接受者相当。与移植后2年内感染风险增加相关的其他因素包括年龄>= 8岁、移植物衰竭和严重急性移植物抗宿主病。这些数据表明，儿童脐带血移植后严重感染的风险与未经处理的骨髓相当。(C)2005年美国血液和骨髓移植学会。
How the infection risks compare after umbilical cord blood (UCB) and bone marrow (BM) transplantation is not known. Therefore, we compared serious infections in the 2 years after pediatric myeloablative unrelated donor transplantation with unmanipulated BM (n = 52), T cell-depleted (TCD) BM (n = 24), or UCB (n = 60) for the treatment of hematologic malignancy. Overall, the cumulative incidence of 1 or more serious infections was comparable between groups (BM, 81%; TCD, 83%; UCB, 90%; P = .12). Furthermore, by taking all serious infections into account and using multivariate techniques with unmanipulated BM as the reference, there were also no significant differences between groups (TCD relative risk [RR], 1.6; P = .10; UCB RR, 1.0; P = .84). Within the time periods days 0 to 42, days 43 to 100, and days 101 to 180, the only difference was a greater risk of viral infections from days 0 to 42 in TCD recipients (RR, 3.5; P = .02). Notably, after day 180, TCD recipients had a significantly increased infection risk (RR, 3.1; P = .03), whereas the risk in UCB recipients (RR, 0.5; P = .23) was comparable to that in BM recipients. Other factors associated with an increased infection risk in the 2 years after transplantation were age >= 8 years, graft failure, and severe acute graft-versus-host disease. These data suggest that the risk of serious infection after pediatric UCB transplantation is comparable to that with unmanipulated BM. (C) 2005 American Society for Blood and Marrow Transplantation.