A Comparison of Outcomes for Cord Blood Transplantation and Unrelated Bone Marrow Transplantation in Adult Aplastic Anemia
A Comparison of Outcomes for Cord Blood Transplantation and Unrelated Bone Marrow Transplantation in Adult Aplastic Anemia
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DOI：
10.1016/j.bbmt.2016.07.002
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发表时间：
2016-10-01
影响因子：
4.3
通讯作者：
Kanda, Yoshinobu
中科院分区：
文献类型：
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作者：
Kuwatsuka, Yachiyo;Kanda, Junya;Kanda, Yoshinobu
早期的研究表明，脐带血移植（UCBT）治疗再生障碍性贫血（AA）是可行的替代移植。为了确定UCBT和HLA匹配或不匹配的非相关骨髓移植（UBMT）在成人AA患者中的结局差异，我们分析了日本造血细胞移植学会的登记数据，并将UCBT（n = 69）与8/8匹配（n = 101），7/8匹配（n = 65）或6/8匹配（n = 37）UBMT的结果进行了比较。移植期为2002年至2012年，16岁或以上AA患者符合条件。UCBT、8/8匹配、7/8匹配和6/8匹配UBMT的中位年龄分别为49、35、28和30岁。在多变量分析中，校正年龄和移植物抗宿主病（GVHD）预防等相关因素后，8/8匹配UBMT的死亡风险低于UCBT（风险比pin.55; 95%可信区间[CI]，.32-.94; P=.029）。7/8匹配UBMT（HR，.55; 95%CI，.29 ~ 1.02）或6/8匹配UBMT（HR，.67; 95%CI，.32 ~ 1.39）的死亡风险与UCBT无显著差异。3级或4级急性和慢性GVHD的风险在4组之间没有差异。最常见的死亡原因是UCBT和6/8匹配UBMT中的移植失败，8/8匹配和7/8匹配UBMT中的感染。在40岁以下，UCBT的生存率与UBMT相似（3年时，UCBT和8/8匹配、7/8匹配和6/8匹配的UBMT分别为76%、79%、83%和83%），校正移植期，这是另一个相关因素;然而，对于年龄超过40岁的患者，UCBT的比例往往较低（3年时，UCBT、8/8匹配、7/8匹配和6/8匹配的UBMT分别为47%、64%、64%和75%）。总之，这些数据表明，UCBT可能是年轻人的替代治疗选择时，匹配的兄弟姐妹或足够的UBMT供体不可用。(C)2016年美国血液和骨髓移植协会。
Earlier reports suggested that umbilical cord blood transplantation (UCBT) for aplastic anemia (AA) was feasible in alternative transplantation. To identify differences in outcomes of UCBT and HLA-matched or mismatched unrelated bone marrow transplantation (UBMT) in adults with AA, we analyzed registry data of the Japan Society for Hematopoietic Cell Transplantation and compared results of UCBT (n = 69) to 8/8-matched (n = 101), 7/8 matched (n = 65), or 6/8-matched (n = 37) UBMT. The transplantation period was from 2002 to 2012, and patients 16 years or older with AA were eligible. Median ages were 49, 35, 28, and 30 years for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively. In multivariate analysis, risk of mortality was lower for 8/8-matched UBMT compared with that of UCBT (hazard ratio pin.55; 95% confidence interval [CI],.32 to.94; P=.029), adjusted for age and graft-versus-host disease (GVHD) prophylaxis, which were other associated factors. Mortality risks of 7/8-matched UBMT (HR,.55; 95% CI,.29 to 1.02) or 6/8-matched UBMT (HR,.67; 95% CI,.32 to 1.39) were not significantly different from those of UCBT. Risks of grade 3 or 4 acute and chronic GVHD were not different among the 4 groups. The most prevalent cause of death was graft failure in UCBT and 6/8-matched UBMT and infection in 8/8-matched and 7/8-matched UBMT. Under 40 years old, survival of UCBT was similar to that of UBMT (76%, 79%, 83%, and 83% for UCBT and 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years), adjusted for transplantation period, which was another associated factor; however, for ages over 40 years, that of UCBT tended to be lower (47%, 64%, 64%, and 75% for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years). To conclude, these data suggest that UCBT could be an alternative treatment option for younger adults when matched sibling or adequate UBMT donors are not available. (C) 2016 American Society for Blood and Marrow Transplantation.