Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies
Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies
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DOI：
10.1182/blood-2004-03-1001
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发表时间：
2004-12-01
期刊：
影响因子：
20.3
通讯作者：
Asano, S
中科院分区：
文献类型：
--
作者：
Takahashi, S;Iseki, T;Asano, S
无关脐带血移植（CBT）现在已经变得越来越普遍，但到目前为止，与骨髓移植（BMT）相比，其结果的报道很少，特别是对于成人。我们研究了113例接受无关BM移植（n = 45）或无关CB移植（n = 68）的恶性血液病成人患者的临床结局。我们使用考克斯比例风险模型分析了造血恢复、移植物抗宿主病（GVHD）发生率、移植相关死亡率（TRM）和复发风险以及无病生存率（DFS）。CB移植受者从寻找供体到移植的时间（中位数，2个月）明显短于BM移植受者（中位数，11个月; P <0.01）。多变量分析显示，与BMT患者相比，CBT患者的中性粒细胞（P <0.01）和血小板（P <0.01）恢复缓慢。尽管移植后免疫抑制剂迅速减少，很少使用类固醇治疗严重的急性GVHD，但CB移植受者中没有GVHD相关死亡，而BM移植受者中有10例死亡。与BMT相比，无关CBT显示出更好的TRM和DFS结果（分别为P = 0.02和P <0.01），尽管人类白细胞抗原错配率更高，输注细胞数量更少。这些数据有力地表明，CBT可以安全有效地用于成人恶性血液病患者。
Unrelated cord blood transplantation (CBT) has now become more common, but as yet there have been only a few reports on its outcome compared with bone marrow transplantation (BMT), especially for adults. We studied the clinical outcomes of 113 adult patients with hematologic malignancies who received unrelated BM transplants (n = 45) or unrelated CB transplants (n = 68). We analyzed the hematopoietic recovery, rates of graft-versus-host disease (GVHD), risks of trans plantation-related mortality (TRM) and relapse, and disease-free survival (DFS) using Cox proportional hazards models. The time from donor search to transplantation was significantly shorter among CB transplant recipients (median, 2 months) than BM transplant recipients (median, 11 months; P < .01). Multivariate analysis demonstrated slow neutrophil (P < .01) and platelet (P < .01) recoveries in CBT patients compared with BMT patients. Despite rapid tapering of immunosuppressants after transplantation and infrequent use of steroids to treat severe acute GVHD, there were no GVHD-related deaths among CB transplant recipients compared with 10 deaths of 24 among BM transplant recipients. Unrelated CBT showed better TRM and DFS results compared with BMT (P = .02 and P < .01, respectively), despite the higher human leukocyte antigen mismatching rate and lower number of infused cells. These data strongly suggest that CBT could be safely and effectively used for adult patients with hematologic malignancies.