Unit selection for umbilical cord blood transplantation for adults with acute myeloid leukemia in complete remission: a Japanese experience
Unit selection for umbilical cord blood transplantation for adults with acute myeloid leukemia in complete remission: a Japanese experience
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DOI：
10.1038/s41409-019-0539-8
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发表时间：
2019-05
影响因子：
4.8
通讯作者：
M. Yanada;T. Konuma;Y. Kuwatsuka;T. Kondo;Takahito Kawata;Satoshi Takahashi;N. Uchida;S. Miyakoshi;Masatsugu Tanaka;Y. Ozawa;M. Sawa;H. Nakamae;N. Aotsuka;J. Kanda;M. Takanashi;Y. Kanda;Y. Atsuta;S. Yano
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文献类型：
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作者：
M. Yanada;T. Konuma;Y. Kuwatsuka;T. Kondo;Takahito Kawata;Satoshi Takahashi;N. Uchida;S. Miyakoshi;Masatsugu Tanaka;Y. Ozawa;M. Sawa;H. Nakamae;N. Aotsuka;J. Kanda;M. Takanashi;Y. Kanda;Y. Atsuta;S. Yano
为了探讨脐带血移植（UCBT）的最佳单位选择，我们对1355例接受单单位UCBT的首次或第二次完全缓解的急性髓系白血病成人进行了一项基于注册的研究。为了符合分析条件，UCB单位必须含有2.0 × 107/kg或更高剂量的总有核细胞（TNC），并且与日本的临床实践一致，HLA-A、-B和-DR抗原至少匹配4/6，这两个标准都比西方国家使用的标准不那么严格。TNC剂量和HLA配型程度均不影响生存率（分别为P= 0.138和P = 0.696）。对于HLA-A、-B抗原和-DRB 1等位基因，HLA配型越好，非复发死亡率越低（P= 0.011），但复发率越高（P= 0.046），生存率无改善（P= 0.680）。考虑每个HLA-A、-B和-DRB 1的等位基因水平对预测非复发死亡率的作用较小（P= 0.198）。这些结果表明，UCB单位选择的不太严格的标准对于日本患者人群是可以接受的，并且在提供更好的机会找到合适的UCB单位方面可能更有益。
To investigate optimal unit selection for umbilical cord blood transplantation (UCBT), we conducted a registry-based study of 1355 adults with acute myeloid leukemia in first or second complete remission who underwent single-unit UCBT. To be eligible for analysis, UCB units had to contain a total nucleated cell (TNC) dose of 2.0 × 107/kg or higher and present at least a 4/6-match for HLA-A, -B, and -DR antigens in line with clinical practice in Japan, both of which are less stringent criteria than those used in Western countries. Neither TNC dose nor the degree of HLA matching affected survival (P= 0.138 andP= 0.696, respectively). As for HLA-A, -B antigens and -DRB1 allele, better HLA matching was associated with lower non-relapse mortality (P= 0.011) but higher relapse (P= 0.046), resulting in no improvement in survival (P= 0.680). Taking the allele level for each HLA-A, -B, and -DRB1 into consideration was less useful for predicting non-relapse mortality (P= 0.198). These findings suggest that the less stringent criteria for UCB unit selection are acceptable for Japanese patient population and perhaps even more beneficial in terms of providing a better chance to find a suitable UCB unit.