Current status of unrelated-donor bone marrow transplantation. The International Marrow Unrelated Search and Transplant (IMUST) Study.
Current status of unrelated-donor bone marrow transplantation. The International Marrow Unrelated Search and Transplant (IMUST) Study.
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发表时间：
1992
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通讯作者：
B. Bradley;J. Hows;S. Gore;J. Bidwell;T. Clay;T. Downie;E. Gluckman;M. Howard;G. Laundy
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作者：
B. Bradley;J. Hows;S. Gore;J. Bidwell;T. Clay;T. Downie;E. Gluckman;M. Howard;G. Laundy
1. 国际骨髓非相关搜索和移植（IMUST）研究1为具有明确临床特征的患者的非相关供体（UD）搜索结果提供了新的预后数据。通过多因素方法分析的病例类型揭示了HLA表型、种族错配和疾病分期在预测搜索结果中的重要性。具有常见HLA类型和早期疾病的白人患者，搜索失败的可能性最小。相比之下，对HLA异常表型和晚期疾病的非白人患者的搜索最有可能失败。重要的是，70%的患者HLA表型被定义为不常见。2. 1989年至1991年间，英国两个登记机构的总体捐赠率为7%，明显低于预期。这一不足的原因是理论预测没有考虑种族不匹配和过时的UD搜索程序以及最重要的hla分型不准确所导致的后勤延误。3. IMUST研究2是一项前瞻性多中心对照队列研究，比较hla -相同兄弟姐妹供体（ID）和ud -骨髓移植（BMT）影响BMT结果的因素。全球83个BMT中心提供了慷慨的支持。本文描述了165例UD- BMT和368例ID-BMT的中期分析，BMT后随访至少6个月。单因素分析显示，UD-后100天植根的概率为89%，而ID-BMT后为98% （p < 0.001）。UD后100天发生II-IV级急性移植物抗宿主病（AGvHD）的概率为52%，而ID-BMT后为42% （p < 0.01）。UD-术后第400天的总生存率为42%，而ID-BMT术后为63% （p < 0.001）。在接受UD-BMT治疗早期疾病的患者中，第400天的生存率为52%，令人鼓舞。4. 对UD-和ID-BMT队列的综合数据进行多因素分析，以确定预测移植、AGvHD和总生存期的各种因素。UD-BMT的中心经验和使用额外的移植前免疫抑制提高了UD-BMT后的生存率。与ID-BMT相比，女性供体对男性受体和低风险疾病的UD- bmt的生存率降低。与UD-BMT相比，在UD-BMT之后，在经历UD-BMT的中心，ID-的植入得到了改善。在慢性髓性白血病和接受女性骨髓的男性患者中，使用体外t细胞清除来预防GvHD会使移植恶化。（摘要删节为400字）
1. The International Marrow Unrelated Search and Transplant (IMUST) Study 1 provides novel prognostic data on outcome of unrelated-donor (UD) searches for patients with well-defined clinical characteristics. Case-types analyzed by multifactorial methods reveal the importance of HLA phenotype, ethnic mismatching, and stage of disease at search request, in predicting search outcome. White patients, with common HLA types and early disease, were least likely to suffer search failure. In contrast, searches for non-White patients with unusual HLA phenotypes and advanced disease were most likely to fail. Of importance, 70% of patients had HLA phenotypes defined as uncommon. 2. Overall donor yield at the 2 UK registries between 1989 and 1991 was 7%, significantly below expectations. Reasons for this shortfall are that theoretical predictions did not consider ethnic mismatch and logistical delays incurred by outdated UD search routines and most importantly HLA-typing inaccuracies. 3. IMUST Study 2 is a prospective multicenter-controlled cohort study comparing HLA-identical sibling donor (ID) and UD-bone marrow transplantation (BMT) for factors affecting BMT outcome. Generous support was provided by 83 BMT centers worldwide. An interim analysis of 165 UD- and 368 ID-BMT, with at least 6 months follow-up after BMT, is described. Unifactorial analysis showed a probability of engraftment at day 100 of 89% after UD- compared with 98% after ID-BMT (p < 0.001). Probability of Grades II-IV acute graft-versus-host disease (AGvHD) at 100 days was 52% after UD- compared with 42% after ID-BMT (p < 0.01). Probability of overall survival at day 400 was 42% after UD- compared with 63% after ID-BMT (p < 0.001). Survival on day 400 of those patients receiving UD-BMT for early disease was encouraging at 52%. 4. Multifactorial analysis was performed on combined data from UD- and ID-BMT cohorts to identify various factors predicting engraftment, AGvHD, and overall survival. Survival after UD-BMT was increased by center experience of UD-BMT and the use of additional pretransplant immunosuppression. Survival was decreased in UD- compared with ID-BMT, by female donor to male recipient and poor-risk disease. Engraftment was improved in ID- compared with UD-BMT, and after UD-BMT at centers experienced in UD-BMT. Engraftment worsened with the use of ex-vivo T-cell depletion for GvHD prophylaxis, in chronic myeloid leukemia, and in male recipients of female marrow.(ABSTRACT TRUNCATED AT 400 WORDS)