Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 units
Relapse risk after umbilical cord blood transplantation: enhanced graft-versus-leukemia effect in recipients of 2 units
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DOI：
10.1182/blood-2009-05-220525
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发表时间：
2009-11-05
期刊：
影响因子：
20.3
通讯作者：
Wagner, John E.
中科院分区：
文献类型：
--
作者：
Verneris, Michael R.;Brunstein, Claudio G.;Wagner, John E.
脐带血移植是治疗急性白血病的一种有效方法。本分析旨在确定与清髓性脐血移植后白血病复发相关的危险因素。急性白血病患者（n = 177; 88例急性淋巴细胞白血病和89例急性髓细胞白血病）在一个中心接受治疗。患者接受了由1个（47%）或2个（53%）部分人类白细胞抗原（HLA）匹配单位组成的UCB移植物。预处理采用环磷酰胺和全身照射（含或不含氟达拉滨）。复发率为26%（95%置信区间[CI]，19%-33%）。在多变量分析中，晚期疾病患者的复发率较高（>=第三次完全缓解[CR 3];相对风险[RR]，3.6; P <0.01），接受2个UCB单位的患者复发率有降低的趋势（RR = 0.6; P = 0.07）。然而，接受2个UCB单位的CR 1 -2患者的复发率较低（RR 0.5; P <0.03）。单单位和双单位受者的无白血病生存率分别为40%（95%CI，30%-51%）和51%（95%CI，41%-62%）（P = 0.35）。尽管已知CR 1和CR2的移植与较低的复发风险相关，但该分析揭示了急性白血病患者在移植2个部分HLA匹配的UCB单位后增强的移植物抗白血病效应。本试验在http://clinicaltrials.gov上注册为NCT 00309842。（血。2009; 114：4293-4299）
Umbilical cord blood (UCB) transplantation is potentially curative for acute leukemia. This analysis was performed to identify risk factors associated with leukemia relapse following myeloablative UCB transplantation. Acute leukemia patients (n = 177; 88 with acute lymphoblastic leukemia and 89 with acute myeloid leukemia) were treated at a single center. Patients received a UCB graft composed of either 1 (47%) or 2 (53%) partially human leukocyte antigen (HLA)-matched unit(s). Conditioning was with cyclophosphamide and total body irradiation with or without fludarabine. The incidence of relapse was 26% (95% confidence interval [CI], 19%-33%). In multivariate analysis, relapse was higher in advanced disease patients (>= third complete remission [CR3]; relative risk [RR], 3.6; P < .01), with a trend toward less relapse in recipients of 2 UCB units (RR = 0.6; P = .07). However, relapse was lower for CR1-2 patients who received 2 UCB units ( RR 0.5; P < .03). Leukemia-free survival was 40% (95% CI, 30%-51%) and 51% (95% CI, 41%-62%) for single- and double-unit recipients, respectively (P = .35). Although it is known that transplantation in CR1 and CR2 is associated with less relapse risk, this analysis reveals an enhanced graft-versus-leukemia effect in acute leukemia patients after transplantation with 2 partially HLA-matched UCB units. This trial was registered at http://clinicaltrials.gov as NCT00309842. (Blood. 2009; 114:4293-4299)