Effect of graft source on unrelated donor haemopoietic stem-cell transplantation in adults with acute leukaemia: a retrospective analysis.
Effect of graft source on unrelated donor haemopoietic stem-cell transplantation in adults with acute leukaemia: a retrospective analysis.
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DOI：
10.1016/s1470-2045(10)70127-3
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发表时间：
2010-07
期刊：
影响因子：
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通讯作者：
National Cord Blood Program of the New York Blood Center
中科院分区：
文献类型：
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作者：
Eapen M;Rocha V;Sanz G;Scaradavou A;Zhang MJ;Arcese W;Sirvent A;Champlin RE;Chao N;Gee AP;Isola L;Laughlin MJ;Marks DI;Nabhan S;Ruggeri A;Soiffer R;Horowitz MM;Gluckman E;Wagner JE;Center for International Blood and Marrow Transplant Research;Acute Leukemia Working Party Eurocord (the European Group for Blood Marrow Transplantation);National Cord Blood Program of the New York Blood Center
脐带血（UCB）越来越被认为是外周血祖细胞（PBPC）或骨髓（BM）的替代品，特别是当HLA匹配的成人无关供体不可用时。为了确定当前移植物选择实践的适当性，我们采用考克斯回归分析，回顾性比较了年龄>16岁的急性白血病移植患者的无白血病生存率和各种移植物来源的其他结局。2002年至2006年期间，使用UCB（n=165），PBPC（n=888）和BM（n=472）移植的1525例患者的数据可用。UCB单位在抗原水平上在HLA-A和B上匹配（n=10），在等位基因水平上在DRB 1上匹配（n=40）或在一个或两个抗原上不匹配（n=115）。来自无关成年供体的PBPC和BM移植物在等位基因水平HLA-A、B、C和DRB 1上匹配（n=632; n=332）或在一个位点上不匹配（n=256; n=140）。UCB移植后的无白血病生存率与8/8和7/8等位基因匹配的PBPC或BM移植后观察到的无白血病生存率相当。然而，与8/8个等位基因匹配的PBPC（HR 1.62，p<0.01）或BM（HR 1.69，p<0.01）相比，UCB移植后的移植相关死亡率更高。与等位基因匹配的PBPC相比，UCB接受者的2-4级急性和慢性移植物抗宿主病较低（分别为HR 0.57，p<0.01和HR 0.38，p<0.01），而与等位基因匹配的BM移植相比，UCB后的慢性和非急性移植物抗宿主病较低（HR 0.63，p=0.01）。总之，这些数据支持当缺乏HLA匹配的无关成人供体和迫切需要移植时，UCB用于急性白血病成人患者。
Umbilical cord blood (UCB) is increasingly considered as an alternative to peripheral blood progenitor cells (PBPC) or bone marrow (BM), especially when a HLA-matched adult unrelated donor is not available. In order to establish the appropriateness of current graft selection practices, we retrospectively compared leukemia-free survival and other outcomes for each graft source in patients aged >16 years transplanted for acute leukemia using Cox regression. Data were available on 1525 patients transplanted between 2002 and 2006 using UCB (n=165), PBPC (n=888) and BM (n=472). UCB units were matched at HLA-A and B at antigen level and DRB1 at allele level (n=10) or mismatched at one (n=40) or two antigens (n=115). PBPC and BM grafts from unrelated adult donors were matched for allele-level HLA-A, B, C and DRB1 (n=632; n=332) or mismatched at one locus (n=256; n=140). Leukemia-free survival after UCB transplantation was comparable to that observed after 8/8 and 7/8 allele-matched PBPC or BM transplantation. Transplant-related mortality, however, was higher after UCB transplantation compared to 8/8 allele-matched PBPC (HR 1.62, p<0.01) or BM (HR 1.69, p<0.01). Grades 2–4 acute and chronic graft-versus-host disease were lower in UCB recipients compared to allele-matched PBPC (HR 0.57, p<0.01 and HR 0.38, p<0.01, respectively), while chronic and not acute graft-versus-host disease was lower after UCB compared to allele-matched BM transplantation (HR 0.63, p=0.01). Together, these data support the use of UCB for adults with acute leukemia when an HLA-matched unrelated adult donor is lacking and when transplant is urgently needed.