Significant improvement in survival after unrelated donor hematopoietic cell transplantation in the recent era.
Significant improvement in survival after unrelated donor hematopoietic cell transplantation in the recent era.
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DOI：
10.1016/j.bbmt.2014.10.001
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发表时间：
2015-01
影响因子：
4.3
通讯作者：
Levine, John E.
中科院分区：
文献类型：
--
作者：
Majhail, Navneet S.;Chitphakdithai, Pintip;Logan, Brent;King, Roberta;Devine, Steven;Rossmann, Susan N.;Hale, Gregory;Hartzman, Robert J.;Karanes, Chatchada;Laport, Ginna G.;Nemecek, Eneida;Snyder, Edward L.;Switzer, Galen E.;Miller, John;Navarro, Willis;Confer, Dennis L.;Levine, John E.
关键词：
患者和医生可能会推迟非血缘关系的供者造血细胞移植(HCT)作为根治疗法，因为与该程序相关的死亡风险。因此，医生在咨询潜在的候选人时，了解当前的结果数据是很重要的。为了提供这一信息，我们评估了2000-2009年间15,059名无血缘关系的捐献者HCT受者。我们比较了四个队列在2005年前后的结果：18岁恶性疾病(N=1,920)，18-59岁恶性疾病(N=9,575)，≥60岁恶性疾病(N=2,194)，以及非恶性疾病(N=1,370)。2005年至2009年的三年总体存活率在所有四个队列中都明显更好(18年：55%对45%，18-59年：42%对35%，≥60年：35%对25%，非恶性疾病：69%对60%，P<；0.001)。对接受HLA7-8/8相合移植的白血病患者进行的多因素分析显示，在2005-2009年接受HCT的患者中，接受HCT后1年的总死亡率和无复发死亡率显著降低；然而，复发的风险并没有随着时间的推移而改变。近十年来，无血缘关系供者HCT后的存活率显著改善，部分原因是患者选择更好(例如，HCT在病程中更早，疾病风险更低)，更好的供者选择(例如，更精确的等位基因水平匹配的无血缘供者)和移植做法的改变。
Patients and physicians may defer unrelated donor hematopoietic cell transplantation (HCT) as curative therapy due to mortality risk associated with the procedure. Therefore, it is important for physicians to know the current outcomes data when counseling potential candidates. To provide this information, we evaluated 15,059 unrelated donor HCT recipients between 2000-2009. We compared outcomes before and after 2005 for four cohorts: age <18 years with malignant diseases (N=1,920), 18-59 years with malignant diseases (N=9,575), ≥60 years with malignant diseases (N=2,194), and non-malignant diseases (N=1,370). Three-year overall survival in 2005-2009 was significantly better in all four cohorts (<18 years: 55% vs. 45%, 18-59 years: 42% vs. 35%, ≥60 years: 35% vs. 25%, non-malignant diseases: 69% vs. 60%, P<0.001 for all comparisons). Multivariate analyses in leukemia patients receiving HLA 7-8/8 matched transplants showed significant reduction in overall and non-relapse mortality in the first 1-year after HCT among patients transplanted in 2005-2009; however, risks for relapse did not change over time. Significant survival improvements after unrelated donor HCT have occurred over the recent decade and can be partly explained by better patient selection (e.g., HCT earlier in the disease course and lower disease risk), improved donor selection (e.g., more precise allele-level matched unrelated donors) and changes in transplant practices.
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影响因子：
4.3
作者：
Bacigalupo, Andrea;Ballen, Karen;Rizzo, Doug;Giralt, Sergio;Lazarus, Hillard;Ho, Vincent;Apperley, Jane;Slavin, Shimon;Pasquini, Marcelo;Sandmaier, Brenda M.;Barrett, John;Blaise, Didier;Lowski, Robert;Horowitz, Mary
通讯作者：
Horowitz, Mary
影响因子：
45.3
作者：
McClune, Brian L.;Weisdorf, Daniel J.;Giralt, Sergio
通讯作者：
Giralt, Sergio
影响因子：
45.3
作者：
Hahn, Theresa;McCarthy, Philip L., Jr.;Majhail, Navneet S.
通讯作者：
Majhail, Navneet S.
影响因子：
45.3
作者：
Wingard, John R.;Majhail, Navneet S.;Socie, Gerard
通讯作者：
Socie, Gerard
影响因子：
45.3
作者：
Horan, John T.;Logan, Brent R.;Pasquini, Marcelo C.
通讯作者：
Pasquini, Marcelo C.