Bone marrow transplantation from related donors other than HLA-identical siblings: effect of T cell depletion.
Bone marrow transplantation from related donors other than HLA-identical siblings: effect of T cell depletion.
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发表时间：
1991-06
影响因子：
4.8
通讯作者：
R. Ash;M. Horowitz;R. Gale;D. Bekkum;J. Casper;E. Gordon-Smith;P. Henslee;H. Kolb;B. Lowenberg-B
中科院分区：
文献类型：
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作者：
R. Ash;M. Horowitz;R. Gale;D. Bekkum;J. Casper;E. Gordon-Smith;P. Henslee;H. Kolb;B. Lowenberg-B
对来自除基因型 HLA 相同的兄弟姐妹（替代相关供体）之外的相关供体的 470 例骨髓移植的结果进行了分析，以确定与移植结果相关的因素，并确定 T 细胞耗竭是否改善了结果。与来自 HLA 相同兄弟姐妹的 3648 例移植相比，替代相关供体移植与移植失败增加、急性移植物抗宿主病 (GVHD) 增加和无病生存率降低相关。不良结果的可能性与供体-受体 HLA 差异的增加相关。在替代相关供体移植的多变量分析中，供体年龄大于或等于 30 岁（相对风险 [RR] 1.7，p 小于 0.006）、中度和晚期白血病（RR 1.5 和 1.6，p 小于 0.01 和 p 小于 0.003）、移植前感染（RR 1.7，p 小于 0.005）以及 2 和 3 位点供体-受体 HLA 差异（RR 1.3，p 小于 0.04）与治疗失败风险增加相关。替代相关供体移植后（n = 43）没有这些不良预后特征的 2 年无白血病生存概率为 44%（95% 置信区间 28-59%），而接受 HLA 相同同胞移植的类似患者（n = 868，单变量 p 小于 0.03）的 2 年无白血病生存概率为 56%（95% 置信区间 52-59%）。 T 细胞耗竭增加了移植失败并降低了替代相关供体移植后的急性 GVHD，但并没有改善无白血病生存率。
Results of 470 bone marrow transplants from related donors other than genotypically HLA-identical siblings (alternative related donors) were analysed to identify factors associated with transplant outcome and to determine whether T cell depletion improved results. As compared to 3648 transplant from HLA-identical siblings, alternative related donor transplants were associated with increased graft failure, increased acute graft-versus-host disease (GVHD), and lower disease-free survival. The likelihood of adverse outcome correlated with increasing donor-recipient HLA-disparity. In multivariate analysis of alternative related donor transplants, donor age greater than or equal to 30 years, (relative risk [RR] 1.7, p less than 0.006), intermediate and advanced leukemia (RR 1.5 and 1.6, p less than 0.01 and p less than 0.003), infection pretransplant (RR 1.7, p less than 0.005) and 2- and 3-locus donor-recipient HLA-disparity (RR 1.3, p less than 0.04) were associated with increased risks of treatment failure. The 2-year probability of leukemia-free survival after alternative related donor transplants (n = 43) with none of these adverse prognostic features was 44% (95% confidence interval 28-59%) compared to 56% (95% confidence interval 52-59%) for similar patients receiving HLA-identical sibling transplants (n = 868, univariate p less than 0.03). T cell depletion increased graft failure and decreased acute GVHD after alternative related donor transplants but did not improve leukemia-free survival.