Engraftment kinetics and graft failure after single umbilical cord blood transplantation using a myeloablative conditioning regimen
Engraftment kinetics and graft failure after single umbilical cord blood transplantation using a myeloablative conditioning regimen
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使用清髓性预处理方案进行单次脐带血移植后的移植动力学和移植失败
作者：
A. Ruggeri;M. Labopin;M. Sormani;G. Sanz;J. Sanz;F. Volt;G. Michel;F. Locatelli;C. D. de Heredia;T. O'Brien;W. Arcese;A. Iori;S. Querol;G. Kogler;L. Lecchi;F. Pouthier;F. Garnier;C. Navarrete;E. Baudoux;J. Fernandes;C. Kenzey;M. Eapen;E. Gluckman;V. Rocha;R. Saccardi
脐带血移植受者面临移植失败的风险增加，这是导致移植相关死亡率较高的并发症。移植失败后进行第二次移植的决定和时机是具有挑战性的。为了解决这一问题，我们分析了1268例急性白血病患者（73%为儿童）（64%为急性淋巴细胞白血病，36%为急性髓系白血病）的移植动力学和结果，这些患者在清髓调节方案后接受了单单位脐带血移植。中位随访时间为31个月。3年总生存率为47%；移植相关死亡率100天累积发生率为16%。较长的移植时间与移植相关的死亡率增加和较短的总生存期相关。第60天中性粒细胞植入的累积发生率为86%，而实现植入的中位时间为24天。概率密度分析显示，脐带血移植后移植的可能性在第10天后增加，在第21天达到峰值，到第31天缓慢下降至21%。第31天以后，移植概率迅速下降，第42天以后的剩余移植概率为5%。166例患者报告了移植失败，其中66例接受了第二次移植（异基因，n=45）。救援行动，如寻找另一个移植物，应该考虑在21天后开始。在第42天中性粒细胞未恢复的患者可诊断为移植物衰竭。此外，后续移植不应推迟至第42天以后。
Umbilical cord blood transplant recipients are exposed to an increased risk of graft failure, a complication leading to a higher rate of transplant-related mortality. The decision and timing to offer a second transplant after graft failure is challenging. With the aim of addressing this issue, we analyzed engraftment kinetics and outcomes of 1268 patients (73% children) with acute leukemia (64% acute lymphoblastic leukemia, 36% acute myeloid leukemia) in remission who underwent single-unit umbilical cord blood transplantation after a myeloablative conditioning regimen. The median follow-up was 31 months. The overall survival rate at 3 years was 47%; the 100-day cumulative incidence of transplant-related mortality was 16%. Longer time to engraftment was associated with increased transplant-related mortality and shorter overall survival. The cumulative incidence of neutrophil engraftment at day 60 was 86%, while the median time to achieve engraftment was 24 days. Probability density analysis showed that the likelihood of engraftment after umbilical cord blood transplantation increased after day 10, peaked on day 21 and slowly decreased to 21% by day 31. Beyond day 31, the probability of engraftment dropped rapidly, and the residual probability of engrafting after day 42 was 5%. Graft failure was reported in 166 patients, and 66 of them received a second graft (allogeneic, n=45). Rescue actions, such as the search for another graft, should be considered starting after day 21. A diagnosis of graft failure can be established in patients who have not achieved neutrophil recovery by day 42. Moreover, subsequent transplants should not be postponed after day 42.
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在HLA A，B，C和DRB1匹配的供体 - 辅助HLA对白血病和骨髓增生综合征的脐带血液移植后结果的影响：回顾性分析。
DOI：
10.1016/s1470-2045(11)70260-1
发表时间：
2011-12
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Eapen M;Klein JP;Sanz GF;Spellman S;Ruggeri A;Anasetti C;Brown M;Champlin RE;Garcia-Lopez J;Hattersely G;Koegler G;Laughlin MJ;Michel G;Nabhan SK;Smith FO;Horowitz MM;Gluckman E;Rocha V;Eurocord-European Group for Blood and Marrow Transplantation;Netcord;Center for International Blood and Marrow Transplant Research
通讯作者：
Center for International Blood and Marrow Transplant Research
影响因子：
20.3
作者：
Liu, Hongtao;Rich, Elizabeth S.;van Besien, Koen
通讯作者：
van Besien, Koen
造血生长因子治疗骨髓移植后移植失败：粒细胞-巨噬细胞集落刺激因子 (GM-CSF) 与序贯 GM-CSF 加粒细胞-CSF 的随机试验。
影响因子：
20.3
作者：
Weisdorf,DJ;Verfaillie,CM;Davies,SM;Filipovich,AH;WagnerJr,JE;Miller,JS;Burroughs,J;Ramsay,NK;Kersey,JH;McGlave,PB
通讯作者：
McGlave,PB
DOI：
10.1016/s1470-2045(10)70127-3
发表时间：
2010-07
期刊：
The Lancet. Oncology
影响因子：
--
作者：
Eapen M;Rocha V;Sanz G;Scaradavou A;Zhang MJ;Arcese W;Sirvent A;Champlin RE;Chao N;Gee AP;Isola L;Laughlin MJ;Marks DI;Nabhan S;Ruggeri A;Soiffer R;Horowitz MM;Gluckman E;Wagner JE;Center for International Blood and Marrow Transplant Research;Acute Leukemia Working Party Eurocord (the European Group for Blood Marrow Transplantation);National Cord Blood Program of the New York Blood Center
通讯作者：
National Cord Blood Program of the New York Blood Center
影响因子：
20.3
作者：
Barker, JN;Weisdorf, DJ;Wagner, JE
通讯作者：
Wagner, JE