Unrelated bone marrow transplantation or immediate umbilical cord blood transplantation for patients with acute myeloid leukemia in first complete remission
Unrelated bone marrow transplantation or immediate umbilical cord blood transplantation for patients with acute myeloid leukemia in first complete remission
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首次完全缓解的急性髓系白血病患者进行无关骨髓移植或立即脐带血移植
作者：
Yanada;M.;Kanda;J.;Ohtake;S.;Fukuda;T.;Sakamaki;H.;Miyamura;K.;Miyawaki;S.;Uchida;N.;Maeda;T.;Nagamura-Inoue;T.;Asou;N.;Morishima;Y.;Atsuta;Y.;Miyazaki;Y.;Kimura;F.;Kobayashi;Y.;Takami;A.;Naoe;T. and Kanda;Y
背景无关骨髓移植（UBMT）已被广泛用作替代供体移植，而脐带血移植（UCBT）的使用正在增加recently.MethodsWe进行了决策分析，以解决移植程序应优先考虑的年轻患者急性髓细胞白血病（AML）窝藏高或中等风险的细胞遗传学在第一次完全缓解（CR 1），当他们缺乏匹配的亲属捐献者，但可以立即获得合适的脐带血单位时。我们分析的主要来源包括三个III期试验的化疗队列（n= 907）和移植队列（n= 752）的注册数据。结果基线分析显示，当考虑8/8匹配UBMT时，UBMT的预期5年生存率高于UCBT（58.1% vs. 51.8%）。即使考虑到UBMT的7/8比赛，这个排名也没有改变。敏感性分析表明，一致的优越性UBMT超过UCBT时，CR 1和UBMT之间的时间流逝是在一个合理的范围内变化3-9 months.ConclusionsThese结果表明，8/8或7/8 UBMT是一个更好的移植选择比UCBT，即使在允许的时间需要捐助者的协调。
BackgroundWhile unrelated bone marrow transplantation (UBMT) has been widely used as alternative donor transplantation, the use of umbilical cord blood transplantation (UCBT) is increasing recently.MethodsWe conducted a decision analysis to address which transplantation procedure should be prioritized for younger patients with acute myeloid leukemia (AML) harboring high‐ or intermediate‐risk cytogenetics in first complete remission (CR1), when they lack a matched related donor but have immediate access to a suitable umbilical cord blood unit. Main sources for our analysis comprised the data from three phase III trials for a chemotherapy cohort (n= 907) and the registry data for a transplantation cohort (n= 752).ResultsThe baseline analysis showed that when the 8/8 match was considered for UBMT, the expected 5‐year survival rate was higher for UBMT than for UCBT (58.1% vs. 51.8%). This ranking did not change even when the 7/8 match was considered for UBMT. Sensitivity analysis showed consistent superiority of UBMT over UCBT when the time elapsed between CR1 and UBMT was varied within a plausible range of 3–9 months.ConclusionsThese results suggest that 8/8 or 7/8 UBMT is a better transplantation option than UCBT even after allowing time required for donor coordination.