Analysis of Risk Factors for Outcomes After Unrelated Cord Blood Transplantation in Adults With Lymphoid Malignancies: A Study by the Eurocord-Netcord and Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
Analysis of Risk Factors for Outcomes After Unrelated Cord Blood Transplantation in Adults With Lymphoid Malignancies: A Study by the Eurocord-Netcord and Lymphoma Working Party of the European Group for Blood and Marrow Transplantation
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DOI：
10.1200/jco.2007.15.8865
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发表时间：
2009-01-10
影响因子：
45.3
通讯作者：
Rocha, Vanderson
中科院分区：
文献类型：
--
作者：
Rodrigues, Celso A.;Sanz, Guillermo;Rocha, Vanderson
PurposeTo determine risk factors of umbilical cord blood transplantation（UCBT）for patients with lymphatic malignancies.Patients and MethodsWe evaluated 104 adult patients（median age，41 years）who undergoed unrelated donor UCBT for lymphatic malignancies. 68%的脐带血移植物是两种抗原人类白细胞抗原不匹配的，由一个（n = 78）或两个（n = 26）单位组成。诊断为非霍奇金淋巴瘤（NHL，n = 61）、霍奇金淋巴瘤（HL，n = 29）和慢性淋巴细胞白血病（CLL，n = 14），其中87%患有晚期疾病，60%经历了既往自体移植失败。64%的患者接受了降低强度的预处理方案和46%的低剂量全身照射（TBI）。中位随访时间为18 months.Results60天时中性粒细胞植入的累积发生率为84%，在CD 34（+）kg/cell剂量较高的受者中植入率更高（P = .0004）。1年时非复发相关死亡率（NRM）的CI为28%，接受低剂量全身照射治疗的患者风险较低（TBI; P = .03）。1年时复发或进展的累积发生率为31%，接受双单位UCBT的患者风险较低（P = 0.03）。1年无进展生存率（PFS）的概率为40%，化疗敏感性疾病患者的生存率提高（49%对34%; P = .03），接受含有低剂量TBI的预处理方案的患者（60%v 23%; P = .001）和更高的有核细胞剂量（49%v 21%; P = .009）。化疗敏感性疾病、使用低剂量TBI和较高的细胞剂量是与显著更好的结果相关的因素。
PurposeTo determine risk factors of umbilical cord blood transplantation (UCBT) for patients with lymphoid malignancies.Patients and MethodsWe evaluated 104 adult patients (median age, 41 years) who underwent unrelated donor UCBT for lymphoid malignancies. UCB grafts were two-antigen human leukocyte antigen-mismatched in 68%, and were composed of one (n = 78) or two (n = 26) units. Diagnoses were non-Hodgkin's lymphoma (NHL, n = 61), Hodgkin's lymphoma (HL, n = 29), and chronic lymphocytic leukemia (CLL, n = 14), with 87% having advanced disease and 60% having experienced failure with a prior autologous transplant. Sixty-four percent of patients received a reduced-intensity conditioning regimen and 46% low-dose total-body irradiation (TBI). Median follow-up was 18 months.ResultsCumulative incidence of neutrophil engraftment was 84% by day 60, with greater engraftment in recipients of higher CD34(+) kg/cell dose (P = .0004). CI of non-relapse-related mortality (NRM) was 28% at 1 year, with a lower risk in patients treated with low-dose total-body irradiation (TBI; P = .03). Cumulative incidence of relapse or progression was 31% at 1 year, with a lower risk in recipients of double-unit UCBT (P = .03). The probability of progression-free survival (PFS) was 40% at 1 year, with improved survival in those with chemosensitive disease (49% v 34%; P = .03), who received conditioning regimens containing low-dose TBI (60% v 23%; P = .001), and higher nucleated cell dose (49% v 21%; P = .009).ConclusionUCBT is a viable treatment for adults with advanced lymphoid malignancies. Chemosensitive disease, use of low-dose TBI, and higher cell dose were factors associated with significantly better outcome.