Cord-Blood Transplantation in Patients with Minimal Residual Disease.
Cord-Blood Transplantation in Patients with Minimal Residual Disease.
复制标题
微小残留病患者的脐带血移植。
DOI：
10.1056/nejmoa1602074
复制
发表时间：
2016-09-08
期刊：
影响因子：
--
通讯作者：
Delaney C
中科院分区：
文献类型：
--
作者：
Milano F;Gooley T;Wood B;Woolfrey A;Flowers ME;Doney K;Witherspoon R;Mielcarek M;Deeg JH;Sorror M;Dahlberg A;Sandmaier BM;Salit R;Petersdorf E;Appelbaum FR;Delaney C
大多数需要造血细胞移植的患者没有匹配的亲属供者。需要数据来告知在各种替代供体细胞来源中的选择。在这项回顾性分析中，我们比较了582名连续急性白血病或骨髓增生异常综合征患者的结果，这些患者接受了来自无关脐带血供者（140名患者）、HLA匹配的无关供者（344）或HLA不匹配的无关供者（98）的首次清髓性造血细胞移植。脐带血组和其他两个无关供者组之间死亡和复发的相对风险似乎根据移植前存在的微小残留疾病状态而变化。在微小残留病患者中，HLA不匹配组的死亡风险高于脐带血组（风险比，2.92; 95%置信区间[CI]，1.52至5.63; P = 0.001）; HLA匹配组的风险也高于脐带血组，但无显著差异。（风险比，1.69; 95% CI，0.94 - 3.02; P = 0.08）。在没有轻微残留疾病的患者中，风险比较低（HLA不匹配组的风险比，1.36; 95%CI，0.76至2.46; P = 0.30; HLA匹配组的风险比，0.78; 95%CI，0.48至1.28; P = 0.33）。两个无关供者组的微小残留病患者的复发风险显著高于脐带血组（HLA不匹配组的风险比为3.01; 95%CI为1.22 ~ 7.38; P = 0.02; HLA匹配组的风险比为2.92; 95%CI为1.34 ~ 6.35; P = 0.007）。在无微小残留病变的患者中，这些相关性的程度较低（HLA不匹配组的风险比为1.28; 95%CI为0.51 ~ 3.25; P = 0.60; HLA匹配组的风险比为1.30; 95%CI为0.65 ~ 2.58; P = 0.46）。我们的数据表明，在移植前有微小残留病的患者中，接受脐带血供者移植后的总体生存概率至少与接受HLA匹配的无关供者移植后的总体生存概率一样有利，并且显著高于接受HLA不匹配的无关供者移植后的总体生存概率。此外，脐带血组的复发概率低于其他两组。
The majority of patients in need of a hematopoietic-cell transplant do not have a matched related donor. Data are needed to inform the choice among various alternative donor-cell sources. In this retrospective analysis, we compared outcomes in 582 consecutive patients with acute leukemia or the myelodysplastic syndrome who received a first myeloablative hematopoietic-cell transplant from an unrelated cord-blood donor (140 patients), an HLA-matched unrelated donor (344), or an HLA-mismatched unrelated donor (98). The relative risks of death and relapse between the cord-blood group and the two other unrelated-donor groups appeared to vary according to the presence of minimal residual disease status before transplantation. Among patients with minimal residual disease, the risk of death was higher in the HLA-mismatched group than in the cord-blood group (hazard ratio, 2.92; 95% confidence interval [CI], 1.52 to 5.63; P = 0.001); the risk was also higher in the HLA-matched group than in the cord-blood group but not significantly so (hazard ratio, 1.69; 95% CI, 0.94 to 3.02; P = 0.08). Among patients without minimal residual disease, the hazard ratios were lower (hazard ratio in the HLA-mismatched group, 1.36; 95% CI, 0.76 to 2.46; P = 0.30; hazard ratio in the HLA-matched group, 0.78; 95% CI, 0.48 to 1.28; P = 0.33). The risk of relapse among patients with minimal residual disease was significantly higher in the two unrelated-donor groups than in the cord-blood group (hazard ratio in the HLA-mismatched group, 3.01; 95% CI, 1.22 to 7.38; P = 0.02; hazard ratio in the HLA-matched group, 2.92; 95% CI, 1.34 to 6.35; P = 0.007). Among patients without minimal residual disease, the magnitude of these associations was lower (hazard ratio in the HLA-mismatched group, 1.28; 95% CI, 0.51 to 3.25; P = 0.60; hazard ratio in the HLA-matched group, 1.30; 95% CI, 0.65 to 2.58; P = 0.46). Our data suggest that among patients with pretransplantation minimal residual disease, the probability of overall survival after receipt of a transplant from a cord-blood donor was at least as favorable as that after receipt of a transplant from an HLA-matched unrelated donor and was significantly higher than the probability after receipt of a transplant from an HLA-mismatched unrelated donor. Furthermore, the probability of relapse was lower in the cord-blood group than in either of the other groups.