Placental blood for bone marrow replacement: the New York Blood Center's program and clinical results
Placental blood for bone marrow replacement: the New York Blood Center's program and clinical results
复制标题
DOI：
10.1053/beha.2000.0106
复制
发表时间：
2000-12-01
影响因子：
2.1
通讯作者：
Stevens, CE
中科院分区：
文献类型：
--
作者：
Rubinstein, P;Stevens, CE
背景和目标。自1988年以来，胎盘/脐带血（PCB）已被用于异体骨髓替代。自1993年以来，纽约血液中心的胎盘血液项目已经开发了收集、测试、冷冻和搜索单位的技术，代表需要造血干细胞替代的非亲属患者，并提供了这些移植结果的分析，确定了与临床结果相关的变量。在这篇综述中，在考虑了该技术的实际和概念方面之后，我们更新了这些移植的临床结果的信息。材料与方法。本报告包括1999年之前我们项目中所有861例PCB移植患者。三分之二被诊断为白血病或淋巴瘤，25%患有遗传性疾病，7%患有获得性疾病。结果数据由各自的移植中心提供，分析包括单变量和多变量回归测试和精算（Kaplan-Meier）技术。超过90%的受者移植成功（Kaplan-Meier估计）。多因素分析证实了细胞剂量、HLA配型、疾病诊断、酸移植中心位置（美国与国外）的影响。患者年龄和HLA匹配等级独立影响急性移植物抗宿主病的频率和严重程度。白血病复发与移植时的疾病分期和先前存在的急性移植物抗宿主病有关。移植相关事件的概率与疾病诊断、剂量、ALA错配数和移植中心独立相关，而在移植成功的患者亚群中，细胞剂量与达到这一终点的相对风险没有显著关联。总的来说，移植后1年无事件生存率，遗传性疾病和血液恶性肿瘤患者分别为49%和30%，获得性疾病患者分别为35%。这些结果证实并扩展了早期的数据，特别是建立了移植成功与组织相容性匹配等级的显著关联，并表明了提高移植匹配水平的紧迫性。
Background and Objectives. Placental/umbilical cord blood (PCB) has been used for allogeneic bone marrow replacement since 1988. The Placental Blood Program of the New York Blood Center has developed techniques for collecting, testing, freezing and searching units on behalf of unrelated patients in need of hematopoietic stem cell replacement since 1993 and provided analysis of the outcomes of these transplants identified variables associated with clinical outcomes. In this review, after considering practical and conceptual aspects of the technology, we update information on the clinical outcomes of these transplants.Materials and Methods. All 861 patients transplanted through 1999 with PCB from our Program are included in this report. Two thirds were diagnosed with leukaemia or lymphoma, 25% with inherited conditions and 7% with acquired diseases. Outcome data were provided by the respective Transplant Center and analyses included both univariate and multivariate regression tests and actuarial (Kaplan-Meier) techniques.Results. Engraftment was achieved by over 90% of recipients (Kaplan-Meier estimate). Multivariate analysis confirmed the influence of cell dose, HLA matching, disease diagnosis acid transplant center location (US vs, foreign). Patient age and HLA match grade independently affected the frequency and severity of acute graft vs. host disease. Leukaemic relapse was associated with the stage of disease at transplantation and the prior existence of acute graft vs. host disease. The probability of transplant-related events was independently associated with disease diagnosis, tell dose, number of ALA mismatches and transplant center, while the cell dose failed to associate significantly with the relative risk of reaching this endpoint in the subset of patients who achieved engraftment. Overall, event-free survival rates at one year post-transplant were 49 and 30%, respectively for genetic disease and haematologic malignancies and 35% for patients with acquired diseases, respectively.Conclusions. These results confirm and extend earlier data, particularly establishing the significant association of transplant success with histocompatibility matching grades, and indicating the urgency of improving the transplant match levels.