Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients
Myeloablative conditioning regimens with combined of haploidentical and cord blood transplantation for myelodysplastic syndrome patients
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单倍相合联合脐带血移植的清髓预处理方案治疗骨髓增生异常综合征患者
DOI：
10.1038/bmt.2017.229
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发表时间：
2018-02-01
影响因子：
4.8
通讯作者：
Ma, X.
中科院分区：
文献类型：
--
作者：
Ke, P.;Bao, X-B;Ma, X.
本研究的目的是通过与同系同胞供者（ISD）移植的比较，评价单倍相合（HID）干细胞联合小剂量第三方供者脐带血（UCB）移植治疗骨髓增生异常综合征（MDS）的策略。2012年1月至2015年12月期间纳入了85例患者，中位年龄为40岁。48例患者接受了单细胞脐带移植，37例患者接受了ISD移植。所有单股脐带患者的单股移植物植入均成功。对于单脐带移植和ISD移植，100天时2-4级急性GvHD的校正累积发生率分别为27%和11%（P = 0.059）; 2年时慢性GvHD的校正累积发生率分别为22%和34%（P = 0.215）。2年调整后的总生存率分别为64%和70%（P = 0.518），无复发生存率分别为56%和66%（P = 0.306）。2年校正累积复发率分别为12%和14%（P = 0.743），非复发死亡率分别为33%和23%（P = 0.291）。总之，Haplo-cord-HSCT实现了与ISD-HSCT治疗MDS相似的结局，并且Haplo-cord-HSCT可能会改善单独HID和UCB-HSCT的结局。因此，当ISD不可用时，单细胞脐带移植可能是治疗MDS的一种更有效的替代方法。
The purpose of this study was to evaluate the strategy of haploidentical (HID) stem cell combined with a small doses of umbilical cord blood (UCB) from a third-party donor transplantation (haplo-cord transplant) for treatment of myelodysplastic syndromes (MDS), by comparing with identical-sibling donor (ISD) transplantation. Eighty-five patients were included between January 2012 and December 2015, with a median 40 years old. Forty-eight patients received haplo-cord transplant and 37 patients received ISD transplant. Haplograft engraftment succeeded in all haplo-cord patients. For haplo-cord and ISD transplantation, adjusted cumulative incidences of grades 2-4 acute GvHD at 100 days were 27 and 11% (P = 0.059); adjusted cumulative incidences of chronic GvHD at 2 years were 22 and 34% (P = 0.215). The 2-year adjusted probabilities of overall survival were 64 and 70% (P = 0.518), and of relapse-free survival were 56 and 66% (P = 0.306). The 2-year adjusted cumulative incidences of relapse were 12 and 14% (P = 0.743), and of non-relapse mortality were 33 and 23% (P = 0.291). In conclusion, haplo-cord-HSCT achieves outcomes similar to those of ISD-HSCT for MDS and the haplo-cord-HSCT may potentially improve the outcome of HID- and UCB-HSCT alone. Thus, the haplo-cord transplantation may be a better valid alternative for MDS when an ISD is not available.