Comparative single-institute analysis of cord blood transplantation from unrelated donors with bone marrow or peripheral blood stem-cell transplants from related donors in adult patients with hematologic malignancies after myeloablative conditioning regimen
Comparative single-institute analysis of cord blood transplantation from unrelated donors with bone marrow or peripheral blood stem-cell transplants from related donors in adult patients with hematologic malignancies after myeloablative conditioning regimen
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DOI：
10.1182/blood-2006-04-020172
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发表时间：
2007-02-01
期刊：
影响因子：
20.3
通讯作者：
Asano, Shigetaka
中科院分区：
文献类型：
--
作者：
Takahashi, Satoshi;Ooi, Jun;Asano, Shigetaka
我们研究了171例成人血液恶性肿瘤患者的临床结果，他们接受了非亲属脐带血移植（CBT）作为主要的非亲属干细胞来源（n = 100），或接受了来自相关供者的骨髓移植（BMT）或外周血干细胞移植（PBSCT） （n = 71, 55 BMT和16 PBSCT）。所有患者均接受骨髓清除方案，包括12 Gy全身照射。我们使用Cox比例风险模型分析了血液学恢复、移植物抗宿主病（GVHD）、移植相关死亡率（TRM）和复发以及无病生存（DFS）的风险。脐带血移植后出现明显的移植延迟；然而，两种移植物的总体植入率几乎相同。CBT接受者中III - IV级急性和广泛型慢性gvhd的累积发病率显著低于BMT/PBSCT接受者。多变量分析显示两组间TRM （CBT组为9%，BMT/PBSCT组为13%）、复发率（CBT组为17%，BMT/PBSCT组为26%）和DFS （CBT组为70%，BMT/PBSCT组为60%）无明显差异。这些数据表明，当非亲属脐带血作为主要的非亲属干细胞来源时，它可能与相关骨髓或动员外周血一样安全有效。
We studied the clinical outcomes of 171 adults with hematologic malignancies who received unrelated cord blood transplantation (CBT) as a primary unrelated stem-cell source (n = 100), or bone marrow transplant (BMT) or peripheral blood stem-cell transplant (PBSCT) from related donors (n = 71, 55 BMT and 16 PBSCT). All patients received myeloablative regimens including 12 Gy total body irradiation. We analyzed the hematologic recovery, and risks of graft-versus-host disease (GVHD), transplantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. Significant delays in engraftment occurred after cord blood transplantation; however, overall engraftment rates were almost the same for both grafts. The cumulative incidences of grades III to IV acute and extensive-type chronic GVHDs among CBT recipients were significantly lower than those among BMT/PBSCT recipients. Multivariate analysis demonstrated no apparent differences in TRM (9% in CBT and 13% in BMT/PBSCT recipients), relapse (17% in CBT and 26% in BMT/PBSCT recipients), and DFS (70% in CBT and 60% in BMT/PBSCT recipients) between both groups. These data suggest that unrelated cord blood could be as safe and effective a stem-cell source as related bone marrow or mobilized peripheral blood for adult patients when it is used as a primary unrelated stem-cell source.