非亲缘脐血移植结局的相关因素：供者选择指南

Factors associated with outcomes of unrelated cord blood transplant: guidelines for donor choice.

作者信息

Gluckman Eliane, Rocha Vanderson, Arcese William, Michel Gérard, Sanz Guillermo, Chan Ka-Wah, Takahashi Tsuneo A, Ortega Juan, Filipovich Alexandra, Locatelli Franco, Asano Shigetaka, Fagioli Franca, Vowels Marcus, Sirvent Anne, Laporte Jean-Philippe, Tiedemann Karin, Amadori Sergio, Abecassis Manuel, Bordigoni Pierre, Diez Blanca, Shaw Peter J, Vora Ajay, Caniglia Maurizio, Garnier Federico, Ionescu Irina, Garcia Joan, Koegler Gesine, Rebulla Paolo, Chevret Sylvie

机构信息

Bone Marrow Transplant Unit and Eurocord Registry, Laboratory of Clinical Research on Cell Therapy, Saint Louis Hospital AP-HP University Paris VII, Paris, France.

出版信息

Exp Hematol. 2004 Apr;32(4):397-407. doi: 10.1016/j.exphem.2004.01.002.

DOI:10.1016/j.exphem.2004.01.002

PMID:15050751

Abstract

OBJECTIVE

Optimizing cord blood donor selection based mainly on cell dose and human leukocyte antigen (HLA) disparities may further improve results of unrelated cord blood transplants (UCBT).

MATERIALS AND RESULTS

We analyzed 550 UCBTs for hematologic malignancies reported to the Eurocord Registry. Main outcomes and prognostic factors were analyzed in univariable and multivariable analyses incorporating center and period effects and using death and relapse as competitive risks for nonfatal endpoints. Nucleated cell (NC) dose before freezing and number of HLA disparities had a significant influence on outcome. Cumulative incidence (CI) of neutrophil and platelet recovery was associated with the number of HLA mismatches, number of NC before freezing, and use of granulocyte colony-stimulating factor. Coexistence of HLA class I and II disparities and high CD34 cell dose in the graft were associated with graft-vs-host disease grades III-IV. CI of disease relapse was higher in matched transplants showing a graft-vs-leukemia effect increased in HLA-mismatched transplants. Overall 3-year survival was 34.4%. Prognostic factors for survival were recipient age, gender, and disease status.

CONCLUSION

Our results provide indications for a better choice of cord blood units according to cord blood cell content and HLA.

摘要

目的

主要基于细胞剂量和人类白细胞抗原（HLA）差异优化脐血供体选择，可能会进一步改善非亲缘脐血移植（UCBT）的效果。

材料与结果

我们分析了向欧洲脐血库登记处报告的550例用于血液系统恶性肿瘤的UCBT。在纳入中心和时期效应并将死亡和复发作为非致命终点的竞争风险的单变量和多变量分析中，分析了主要结局和预后因素。冷冻前有核细胞（NC）剂量和HLA差异数量对结局有显著影响。中性粒细胞和血小板恢复的累积发生率（CI）与HLA错配数量、冷冻前NC数量以及粒细胞集落刺激因子的使用有关。移植物中HLA I类和II类差异共存以及高CD34细胞剂量与III-IV级移植物抗宿主病相关。在显示移植物抗白血病效应的匹配移植中，疾病复发的CI较高，在HLA错配移植中增加。总体3年生存率为34.4%。生存的预后因素是受者年龄、性别和疾病状态。