Impact of donor types on reduced-intensity conditioning allogeneic stem cell transplant for mature lymphoid malignancies
Impact of donor types on reduced-intensity conditioning allogeneic stem cell transplant for mature lymphoid malignancies
复制标题
DOI：
10.1038/s41409-021-01525-1
复制
发表时间：
2021-11-24
影响因子：
4.8
通讯作者：
Kanda，Junya
中科院分区：
文献类型：
--
作者：
Imahashi，Nobuhiko;Terakura，Seitaro;Kanda，Junya
我们回顾性比较了来自匹配的亲属供者（MRD;n= 266）、匹配的非亲属供者（MUD;n= 277）和脐带血（UCB;n= 513）的低强度预处理（RIC）移植治疗成熟淋巴系统恶性肿瘤的结局。MRD、MUD和UCB组的3年总生存率分别为54%、59%和40%（P< 0.001）。多变量分析显示MRD组与MUD或UCB组之间的生存率无差异。然而，在UCB组中，预处理方案和移植物抗宿主病（GVHD）预防对生存率有显著影响，但在MRD和MUD组中无影响。值得注意的是，多变量分析显示，接受最佳预处理方案和GVHD预防的UCB受者（n= 116）的总体死亡率风险低于MRD组（相对风险[RR]，0.69;P= 0.03），并倾向于低于MUD组（RR，0.75;P= 0.09）。我们的研究结果表明，脐血移植与最佳的预处理方案和GVHD预防是非常有效的。此外，UCB是现成的。因此，UCB移植与最佳的预处理方案和GVHD的预防是最好的MUD移植时，MRD是不可用的RIC移植成熟的淋巴系统恶性肿瘤的设置。
We retrospectively compared the outcomes of reduced-intensity conditioning (RIC) transplantation from matched related donors (MRD;n= 266), matched unrelated donors (MUD;n= 277), and umbilical cord blood (UCB;n= 513) for mature lymphoid malignancies. The 3-year overall survival rates for the MRD, MUD, and UCB groups were 54%, 59%, and 40%, respectively (P< 0.001). Multivariate analysis showed no differences in survival between the MRD group and the MUD or UCB group. However, survival was significantly affected by the conditioning regimen and graft-versus-host disease (GVHD) prophylaxis in the UCB group, but not in the MRD and MUD groups. Notably, multivariate analysis showed that the risk of overall mortality in the UCB recipients who received the optimal conditioning regimen and GVHD prophylaxis (n= 116) was lower than that in the MRD group (relative risk [RR], 0.69;P= 0.03) and tended to be lower than that in the MUD group (RR, 0.75;P= 0.09). Our results suggest that UCB transplantation performed with the optimal conditioning regimen and GVHD prophylaxis is highly effective. Moreover, UCB is readily available. Thus, UCB transplantation with the optimal conditioning regimen and GVHD prophylaxis is preferable to MUD transplantation when MRD are not available in the setting of RIC transplantation for mature lymphoid malignancies.