Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities.
Availability of cord blood extends allogeneic hematopoietic stem cell transplant access to racial and ethnic minorities.
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DOI：
10.1016/j.bbmt.2010.08.011
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发表时间：
2010-11
影响因子：
4.3
通讯作者：
van den Brink, Marcel R. M.
中科院分区：
文献类型：
--
作者：
Barker, Juliet N.;Byam, Courtney E.;Kernan, Nancy A.;Lee, Sinda S.;Hawke, Rebecca M.;Doshi, Kathleen A.;Wells, Deborah S.;Heller, Glenn;Papadopoulos, Esperanza B.;Scaradavou, Andromachi;Young, James W.;van den Brink, Marcel R. M.
对于没有合适的兄弟姐妹捐赠者的种族和少数民族患者来说，异基因移植的机会可能会受到严重限制。脐带血(CB)移植是否可以扩大移植途径，这是由于降低了所需的HLA配型的严格性，目前还没有得到证实。我们根据患者血统前瞻性地评估了553名没有合适兄弟姐妹捐赠者的患者中非亲属供者(URD)和CB的可用性。如果有足够的捐赠者，URDS优先。另外，选择HLA4/6HLA4/6相合的脐带血移植物，采用双单位法增加移植物剂量。患者的祖先非常不同，包括35%的非欧洲人。在接受联合搜索的525名患者中，53%的欧洲血统患者中发现了10/10的人类白细胞抗原相合的URD，但在非欧洲血统的患者中只有21%(p<；0.001)。然而，两组中的大多数都有5-6/6个CB单位。269名URD移植受者主要是欧洲人，非欧洲人只占23%。相比之下，56%的脐带血移植受者有非欧洲血统(P<；0.001)。在26名没有任何合适干细胞来源的患者中，73%有非欧洲血统(P<；0.001)。他们的平均体重显著高于脐带血移植受者(P<；0.001)，部分原因是他们没有接受脐带血移植。CB的可获得性极大地扩大了异基因移植的机会，特别是在非欧洲患者中，并且无论种族或民族如何，都具有提供合适干细胞来源的最大潜力。少数族裔患者需要异基因移植，但没有合适的匹配同胞供者，应转介进行URD和CB联合搜索，以优化移植途径。
Allogeneic transplant access can be severely limited for patients of racial and ethnic minorities without suitable sibling donors. Whether cord blood (CB) transplantation can extend transplant access due to the reduced stringency of required HLA-match is not proven. We prospectively evaluated availability of unrelated donors (URD) and CB according to patient ancestry in 553 patients without suitable sibling donors. URDs had priority if adequate donors were available. Otherwise ≥ 4/6 HLA-matched CB grafts were chosen utilizing double units to augment graft dose. Patients had highly diverse ancestries including 35% non-Europeans. In 525 patients undergoing combined searches, 10/10 HLA-matched URDs were identified in 53% of those with European ancestry, but only 21% of patients with non-European origins (p < 0.001). However, the majority of both groups had 5–6/6 CB units. The 269 URD transplant recipients were predominantly European, with non-European patients accounting for only 23%. By contrast, 56% of CB transplant recipients had non-European ancestries (p < 0.001). Of 26 patients without any suitable stem cell source, 73% had non-European ancestries (p < 0.001). Their median weight was significantly higher than CB transplant recipients (p < 0.001), partially accounting for their lack of a CB graft. Availability of CB significantly extends allo-transplant access, especially in non-European patients, and has the greatest potential to provide a suitable stem cell source regardless of race or ethnicity. Minority patients in need of allografts, but without suitable matched sibling donors, should be referred for combined URD and CB searches to optimize transplant access.
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影响因子：
6.2
作者：
Mori, M;Beatty, PG;Milford, EL
通讯作者：
Milford, EL
影响因子：
2.9
作者：
Kurtzberg, J;Cairo, MS;Kernan, NA
通讯作者：
Kernan, NA
影响因子：
45.3
作者：
Rodrigues, Celso A.;Sanz, Guillermo;Rocha, Vanderson
通讯作者：
Rocha, Vanderson
影响因子：
2.7
作者：
Hurley, Carolyn Katovich;Fernandez-Vina, Marcelo;Setterholm, Michelle
通讯作者：
Setterholm, Michelle
影响因子：
6.2
作者：
BEATTY, PG;MORI, M;MILFORD, E
通讯作者：
MILFORD, E