Prospective study of one- vs two-unit umbilical cord blood transplantation following reduced intensity conditioning in adults with hematological malignancies.
Prospective study of one- vs two-unit umbilical cord blood transplantation following reduced intensity conditioning in adults with hematological malignancies.
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DOI：
10.1038/bmt.2011.195
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发表时间：
2012-07
影响因子：
4.8
通讯作者：
Laughlin MJ
中科院分区：
文献类型：
--
作者：
Kindwall-Keller TL;Hegerfeldt Y;Meyerson HJ;Margevicius S;Fu P;van Heeckeren W;Lazarus HM;Cooper BW;Gerson SL;Barr P;Tse WW;Curtis C;Fanning LR;Creger RJ;Carlson-Barko JM;Laughlin MJ
由于成人单单位脐带血(UCB)有核细胞剂量的阈值迄今尚未确定，我们前瞻性地比较了成人恶性血液病患者在降低强度预适应(RIC)后进行单单位和2单位脐带血移植的疗效。研究设计：如果冻存总有核细胞剂量为HLA2.5×10~7/kg受者体重，则输注1个脐血单位，否则输注至少4/6个≥座位和3/6个相互匹配的2个单位。27例患者接受1个单位治疗，23例患者接受2个单位治疗。中位时间达到绝对中性粒细胞计数(ANC)和GT；500/μL为24天(95%可信区间22-28天)，1个单位25天，2个单位23天(P=0.99)。第100天，1单位组和2单位组ANC500/μL分别为88.4%和91.3%(P=0.99)。1单位组和2单位组的三年无事件生存率分别为28.6%和39.1%(p=0.71)。输注2个单位的患者复发风险显著降低，分别为30.4%和59.3%(p=0.045)。细胞输注剂量(TNC、CD3+、CD34+、CD56+CD3neg)对植入率、总存活率(OS)和EFS无影响。总之，RIC后门槛细胞剂量≥为2.5×10~7/kg受者体重的单单位脐血移植对成人来说是一种可行的选择，尽管输注2个单位复发率较低。
As the threshold nucleated cell dose for single unit umbilical cord blood (UCB) in adults has not to date been firmly established, we prospectively compared single vs. 2-unit UCB transplantation after reduced intensity conditioning (RIC) in adult patients with hematologic malignancies. Study design specified one UCB unit if the cryopreserved total nucleated cell (TNC) dose was ≥2.5×107/kg recipient weight, otherwise 2-units matched at minimum 4/6 HLA loci to the patient and 3/6 to each other were infused. Twenty-seven patients received 1 unit; 23 patients received 2 units. Median time to absolute neutrophil count (ANC) >500/μL was 24 days (95% CI 22–28 days), 25 days for 1-unit and 23 days for 2-units (p=0.99). At day 100, ANC >500/μL was 88.4% and 91.3% in the 1 and 2-unit groups (p=0.99), respectively. Three-year event free survival (EFS) was 28.6% and 39.1% in the 1 and 2-unit groups (p=0.71), respectively. Infusion of 2 units was associated with significantly lower relapse risk, 30.4% vs. 59.3% (p=0.045). Infused cell doses (TNC, CD3+, CD34+, CD56+CD3neg) did not impact engraftment, overall survival (OS), or EFS. Taken together, single unit UCB transplantation with threshold cell dose ≥2.5×107/kg recipient weight after RIC is a viable option for adults, although infusion of 2 units confers a lower relapse incidence.