Outcome of cord-blood transplantation from related and unrelated donors
Outcome of cord-blood transplantation from related and unrelated donors
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DOI：
10.1056/nejm199708073370602
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发表时间：
1997-08-07
影响因子：
158.5
通讯作者：
Chastang, C
中科院分区：
文献类型：
--
作者：
Gluckman, E;Rocha, V;Chastang, C
背景脐带血库增加了血液病患者脐带血移植的使用。我们已经建立了一个注册表，包含的结果cord-blood transplantation.Methods的信息，我们发送了调查问卷，45个移植中心的信息接受cord-blood transplants从1988年至1996年。报告143移植，在45个中心进行了研究，和反应分别进行了分析，根据是否捐助者是相关或无关的recipient.Results在78个受体的脐带血从相关的捐助者，Kaplan-Meier估计的生存率在一年为63%。年龄较小、体重较轻、移植物来自HLA相合的供者和受者巨细胞病毒血清学阴性是有利的预后因素。在60名HLA匹配的脐带血接受者中，至少II级的移植物抗宿主病发生率估计为9%，在18名HLA不匹配的脐带血接受者中，至少II级的移植物抗宿主病发生率估计为50%。中性粒细胞植入与年龄小于6岁（P = 0.02）和体重小于20 kg（P = 0.02）相关，并且在每千克体重接受3700万或更多有核细胞的患者中，85%发生。在65名接受无关供体脐带血的患者中，Kaplan-Meier估计一年生存率为29%。巨细胞病毒阴性血清学状态与这些受者的生存率提高相关（P = 0.03），是移植物抗宿主病最重要的预测因子（P = 0.04）。从无关捐赠者那里接受每公斤3700万个或更多有核细胞的患者中，94%的中性粒细胞恢复。结论脐带血是儿科和一些患有严重血液病的成人患者的可行的造血干细胞替代来源，特别是如果捐赠者和接受者有亲属关系。(C)1997年，马萨诸塞州医学会。
Background Cord-blood banks have increased the use of cord-blood transplantation in patients with hematologic disorders. We have established a registry containing information on the outcome of cord-blood transplantation.Methods We sent questionnaires to 45 transplantation centers for information on patients receiving cord-blood transplants from 1988 to 1996. Reports on 143 transplantations, performed at 45 centers, were studied, and the responses were analyzed separately according to whether the donor was related or unrelated to the recipient.Results Among 78 recipients of cord blood from related donors, the Kaplan-Meier estimate of survival at one year was 63 percent. Younger age, lower weight, transplants from HLA-identical donors, and cytomegalovirus-negative serologic results in the recipient were favorable prognostic factors. Graft-versus-host disease of at least grade II occurred at estimated rates of 9 percent in 60 recipients of HLA-matched cord blood and 50 percent in 18 recipients of HLA-mismatched cord blood. Neutrophil engraftment was associated with an age of less than six years (P = 0.02) and a weight of less than 20 kg (P = 0.02), and it occurred in 85 percent of patients receiving 37 million or more nucleated cells per kilogram of body weight. Among 65 patients who received cord blood from unrelated donors, the Kaplan-Meier estimate of survival at one year was 29 percent. Cytomegalovirus-negative serologic status in these recipients was associated with improved survival (P = 0.03) and was the most important predictor of graft-versus-host disease (P = 0.04). Neutrophil recovery occurred in 94 percent of the patients who received 37 million or more nucleated cells per kilogram from unrelated donors.Conclusions Cord blood is a feasible alternative source of hematopoietic stem cells for pediatric and some adult patients with major hematologic disorders, particularly if the donor and the recipient are related. (C) 1997, Massachusetts Medical Society.