Hows J M, Passweg J R, Tichelli A, Locasciulli A, Szydlo R, Bacigalupo A, Jacobson N, Ljungman P, Cornish J, Nunn A, Bradley B, Socié G
Department of Biomedical Sciences, Faculty of Applied Sciences, University of the West of England, Bristol, UK.
Bone Marrow Transplant. 2006 Dec;38(12):799-805. doi: 10.1038/sj.bmt.1705531. Epub 2006 Oct 30.
Long-term survivors of hematopoietic stem cell transplants remain at risk of potentially fatal complications that detract from life quality. Long-term morbidity and mortality were compared between matched recipient cohorts surviving 2 or more years and defined by donor type, HLA matched sibling donor (MSD) or volunteer unrelated donor (URD). Patients were previously entered into the prospective multicenter International Unrelated Search and Transplant Study. Thirty-nine centers provided data on 108 URD and 355 MSD recipients surviving more than 2 years. Long-term survival, performance status, chronic GvHD (c-GvHD), secondary malignancy, endocrine dysfunction, cataracts, bone necrosis and dental pathology were compared between cohorts. Twelve year survival was 77+/-5% for the MSD and 67+/-11% for the URD cohort (P=0.1). Late death occurred in 105 of 463 recipients alive at 2 years, 73 after 355 (21%) MSD and 32 after 108 (30%) URD transplants, P=0.10. Of 105 deaths, the cause was relapse in 60 and unrelated to relapse in 45 cases. Cumulative incidence of extensive c-GvHD (P=0.002), cataracts (P=0.02) and bone necrosis (P=0.02) was higher after URD transplants. No long-term difference in endocrine dysfunction, secondary malignancy and major dental pathology was detected. This landmark study will assist physicians counseling patients pre-transplant and with their long-term care post transplant.
造血干细胞移植的长期存活者仍面临可能致命的并发症风险，这些并发症会降低生活质量。对存活2年或更长时间的匹配受者队列，根据供者类型（HLA匹配的同胞供者[MSD]或志愿非血缘供者[URD]）比较长期发病率和死亡率。患者先前已纳入前瞻性多中心国际非血缘搜索与移植研究。39个中心提供了108例URD受者和355例MSD受者存活超过2年的数据。比较了队列之间的长期生存、功能状态、慢性移植物抗宿主病（c-GvHD）、继发性恶性肿瘤、内分泌功能障碍、白内障、骨坏死和牙齿病变情况。MSD队列的12年生存率为77±5%，URD队列为67±11%（P=0.1）。463例2年存活的受者中有105例发生晚期死亡，355例MSD移植后有73例（21%），108例URD移植后有32例（30%），P=0.10。105例死亡中，60例原因是复发，45例与复发无关。URD移植后广泛c-GvHD（P=0.002）、白内障（P=0.02）和骨坏死（P=0.02）的累积发生率更高。未检测到内分泌功能障碍、继发性恶性肿瘤和严重牙齿病变的长期差异。这项具有里程碑意义的研究将有助于医生在移植前为患者提供咨询，并在移植后进行长期护理。
