A phase I/II trial of intrabone marrow cord blood transplantation and comparison of the hematological recovery with the Japanese nationwide database
A phase I/II trial of intrabone marrow cord blood transplantation and comparison of the hematological recovery with the Japanese nationwide database
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DOI：
10.1038/bmt.2016.319
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发表时间：
2017-04-01
影响因子：
4.8
通讯作者：
Chiba, S.
中科院分区：
文献类型：
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作者：
Kurita, N.;Gosho, M.;Chiba, S.
骨髓内脐带血移植（IB-CBT）被认为是一种有前途的治疗方式，以改善血液学恢复。然而，IB-CBT相对于传统IV CBT的临床优势尚不清楚。我们进行了一项IB-CBT的前瞻性单中心试验，以评估其在血液学恢复方面的安全性和优越性。入组了15名患有血液恶性肿瘤的成人。在局部麻醉下，将解冻和未洗涤的单个脐带血单位注射到双侧髂嵴上后。中性粒细胞和血小板植入13例，中位数分别为17天和45天。对于对照组，我们从日本全国数据库中提取数据，并比较同期移植的1135例CBT病例的血液学恢复情况。多变量分析显示IB-CBT促进血小板恢复（风险比，2.13; P = 0.007），但中性粒细胞恢复无显著差异（风险比，1.70; P = 0.19）。在第14天，在髂骨骨髓中观察到比胸骨更好的供体嵌合体，表明注射部位的局部造血比远端骨髓部位更早建立。总的来说，IB-CBT耐受性良好，可以增强局部植入，这比IV-CBT更快地促进血小板恢复。
Intrabone marrow cord blood transplantation (IB-CBT) was proposed as a promising treatment modality to improve hematological recovery. However, clinical advantages of IB-CBT over conventional IV CBT have been unclear. We conducted a prospective single-center trial of IB-CBT to evaluate its safety and superiority in terms of hematological recovery. Fifteen adults with hematological malignancies were enrolled. A thawed and unwashed single cord blood unit was injected into the bilateral superior-posterior iliac crests under local anesthesia. Engraftments of neutrophils and platelets were achieved in 13 cases, with medians of 17 and 45 days, respectively. For the control, we extracted data from the Japanese nationwide database and compared the hematological recovery of contemporaneously transplanted 1135 CBT cases. Multivariate analysis revealed that IB-CBT enhanced platelet recovery (hazard ratio, 2.13; P = 0.007), but neutrophil recovery did not differ significantly (hazard ratio, 1.70; P = 0.19). Better donor chimerism was seen in the bone marrow of the ilium than of the sternum on day 14, suggesting that the local hematopolesis at the injected site was established earlier than that at the remote bone marrow site. Collectively, IB-CBT was well tolerated and may enhance local engraftment, which promotes prompter platelet recovery than does IV-CBT.