Cord blood is a suitable donor source of allogeneic hematopoietic cell transplantation for adult T-cell leukemia-lymphoma: a nationwide retrospective study
Cord blood is a suitable donor source of allogeneic hematopoietic cell transplantation for adult T-cell leukemia-lymphoma: a nationwide retrospective study
复制标题
脐带血是成人 T 细胞白血病-淋巴瘤同种异体造血细胞移植的合适供体来源：一项全国性回顾性研究
DOI：
10.1038/s41409-023-01919-3
复制
发表时间：
2023
影响因子：
4.8
通讯作者：
Kato Koji.
中科院分区：
文献类型：
--
作者：
Tokunaga Masahito;Nakano Nobuaki;Fuji Shigeo;Kato Koji.
尽管同种异体造血细胞移植（allo-HCT）是一种治疗侵袭性成人T细胞白血病淋巴瘤（ATL）的方法[1, 2]，但据报道，与其他供体来源相比，用于ATL的脐带血移植（CBT）的预后明显较差[3-5]。由于 ATL 需要快速 HCT，且最近 CBT 的疗效有所提高，因此 ATL 的 CBT 已常规实施 [6]。因此，我们使用移植登记统一管理程序，从日本全国数据库日本移植和细胞治疗协会（JSTCT）回顾性地重新评估了 ATL 的 CBT [7]。我们收集了 2008 年至 2017 年间首次接受异基因 HCT 的最大 ATL 患者队列的数据。该研究得到了 JSTCT 数据管理委员会和今村综合医院机构审查委员会的批准。所有 CBT 接受者都收到一个单位。总生存期（OS）是从 HCT 时间开始计算，直至死亡或最后一次随访。死亡原因分为 ATL 相关死亡率 (ATL-RM) 或移植相关死亡率 (TRM)。 TRM 被定义为除 ATL-RM 之外的任何死亡。对最后一次随访时仍然活着的患者进行了审查。使用描述性统计总结与患者和 HCT 特征相关的变量。进行倾向评分匹配 (PSM) 分析，以最大限度地减少治疗选择偏差并消除接受 CBT 的患者（CBT 组）和接受其他捐赠者来源的 HCT 的患者（非 CBT 组）之间的混杂偏差。使用Logistic回归根据与早期研究结果相关的以下变量计算倾向评分：年龄、性别、临床亚型、体力状态（PS）、造血细胞移植特异性合并症指数（HCT-CI）、疾病状态、从初次诊断到HCT的时间间隔、ABO匹配、受者和供者之间的性别组合、预处理方案和GVHD预防。采用最接近方法创建 1:1 匹配的研究组。所有统计分析均使用 EZR 1.52 版软件（日本埼玉县自治医科大学埼玉医疗中心）进行，该软件是 R 4.0 的图形用户界面。 0（R统计计算基金会）[8]。2008-2017年，日本有446名ATL患者接受了CBT，我们比较了2008-2012年和2013-2017年患者的特征和HCT结果（补充表1）。 2013-2017 年接受 HCT 的中位年龄比 2008-2012 年大 3 岁（61 岁 vs 58 岁，范围：31-78 岁 vs 24-72 岁，
Although allogeneic hematopoietic cell transplantation (allo-HCT) is a curative treatment for aggressive-type adult T-cell leukemialymphoma (ATL)[1, 2], it has been reported that cord blood transplantation (CBT) for ATL is associated with significantly worse prognosis compared with other donor sources [3-5]. CBT for ATL has been routinely implemented in Japan as ATL requires rapid HCT and the efficacy of CBT has recently improved [6]. Therefore, we retrospectively re-evaluated CBT for ATL from a nationwide Japanese database, the Japan Society for Transplantation and Cellular Therapy (JSTCT) using the Transplant Registry Unified Management Program [7]. We collected data from the largest cohort on patients with ATL who received first allo-HCT between 2008 and 2017. The study was approved by the JSTCT data management committees and Imamura General Hospital Institutional Review Board. All CBT recipients received a single unit. Overall survival (OS) was calculated from the time of HCT until death or the last follow-up. The cause of death was categorized as either ATL-related mortality (ATL-RM) or transplantation-related mortality (TRM). TRM was defined as any death other than ATL-RM. Patients who remained alive at the time of the last follow-up were censored. Descriptive statistics were used to summarize the variables related to the patients and HCT characteristics. A propensity score-matched (PSM) analysis was performed to minimize treatment selection bias and eliminate confounding bias between the patients who received CBT (CBT group) and the patients who received HCT from other donor sources (non-CBT group). Logistic regression was used for the propensity score calculation from the following variables that were relevant to earlier research findings: age, sex, clinical subtype, performance status (PS), hematopoietic cell transplantation-specific comorbidity index (HCT-CI), disease status, the interval from initial diagnosis to HCT, ABO matching, sex combination between recipient and donor, conditioning regimen, and GVHD prophylaxis. A 1: 1 matched study group was created with the use of the nearest approach. All statistical analyses were performed using EZR Version 1.52 software (Saitama Medical Center, Jichi Medical University, Saitama, Japan), a graphical user interface for R 4.0. 0 (R Foundation for Statistical Computing)[8].From 2008-2017, 446 patients with ATL received CBT in Japan, and we compared the characteristics and HCT outcomes of patients between 2008-2012 and 2013-2017 (Supplementary Table 1). The median age at HCT in 2013-2017 was 3 years older than in 2008-2012 (61 vs 58 years, range: 31-78 vs 24-72,