Drobyski William R, Klein John, Flomenberg Neal, Pietryga Daniel, Vesole David H, Margolis David A, Keever-Taylor Carolyn A
Bone Marrow Transplant Program, Froedtert Memorial Lutheran Hospital, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
Blood. 2002 Feb 1;99(3):806-14. doi: 10.1182/blood.v99.3.806.
The purpose of this study was to compare transplantation outcomes in patients with hematologic malignancies who received marrow grafts from either phenotypically matched unrelated, one-antigen-mismatched unrelated, or highly human leukocyte antigen (HLA)-disparate family donors. Between 1993 and 2000, 139 patients underwent transplantation from unrelated donors (81 matched and 58 mismatched) and 48 patients received marrow grafts from family donors that were mismatched at 2, 3, or 4 of 8 HLA loci. All patients received a standardized conditioning regimen and a graft-versus-host disease (GVHD) prophylaxis schedule with the exception of recipients of haploidentical marrow grafts, who received antithymocyte globulin after bone marrow transplantation as additional immunosuppression. There was no statistically significant difference in the rate of engraftment, or the cumulative incidences of acute and chronic GVHD between any of the 3 groups. The 2-year cumulative incidence of relapse was lower in matched unrelated patients (25%, P =.01) and mismatched unrelated patients (26%, P =.014) than in haploidentical patients (42%). Transplant-related mortality was significantly higher in recipients of mismatched unrelated grafts (45%, P =.01) and haploidentical grafts (42%, P =.001) compared with recipients of matched unrelated marrow grafts (23%). This resulted in a significantly higher probability of overall survival for matched unrelated patients (58%) versus either mismatched unrelated (34%, P =.01) or haploidentical (21%, P =.002) patients. There was no statistically significant difference in survival between patients who received mismatched unrelated grafts versus those who received haploidentical grafts. This study supports a donor selection algorithm whereby patients who lack a closely matched family donor be offered a phenotypically matched unrelated donor if available. There is no apparent advantage to using a mismatched unrelated versus a highly HLA-disparate family donor.
本研究的目的是比较血液系统恶性肿瘤患者接受来自表型匹配的无关供者、一个抗原不匹配的无关供者或高度人类白细胞抗原（HLA）不匹配的家族供者的骨髓移植后的移植结局。1993年至2000年期间，139例患者接受了无关供者的移植（81例匹配，58例不匹配），48例患者接受了在8个HLA位点中的2个、3个或4个位点不匹配的家族供者的骨髓移植。所有患者均接受标准化的预处理方案和移植物抗宿主病（GVHD）预防方案，但单倍体相合骨髓移植受者除外，他们在骨髓移植后接受抗胸腺细胞球蛋白作为额外的免疫抑制。三组之间的植入率、急性和慢性GVHD的累积发生率均无统计学显著差异。匹配的无关供者患者（25%，P = 0.01）和不匹配的无关供者患者（26%，P = 0.014）的2年复发累积发生率低于单倍体相合患者（42%）。与匹配的无关骨髓移植受者（23%）相比，不匹配的无关移植物受者（45%，P = 0.01）和单倍体相合移植物受者（42%，P = 0.001）的移植相关死亡率显著更高。这导致匹配的无关供者患者的总生存概率显著高于不匹配的无关供者患者（34%，P = 0.01）或单倍体相合患者（21%，P = 0.002）。接受不匹配的无关移植物的患者与接受单倍体相合移植物的患者之间的生存无统计学显著差异。本研究支持一种供者选择算法，即如果有表型匹配的无关供者，缺乏紧密匹配的家族供者的患者应优先选择。使用不匹配的无关供者与高度HLA不匹配的家族供者相比没有明显优势。
