Moore John, Nivison-Smith Ian, Goh Kim, Ma David, Bradstock Ken, Szer Jeff, Durrant Simon, Schwarer Anthony, Bardy Peter, Herrmann Richard, Dodds Anthony
Haematology Department, St. Vincent's Hospital, Darlinghurst, NSW, Australia.
Biol Blood Marrow Transplant. 2007 May;13(5):601-7. doi: 10.1016/j.bbmt.2007.01.073. Epub 2007 Mar 23.
Recent studies have shown comparable survival outcomes for unrelated donor (URD) stem cell transplantation in chronic myelogenous leukemia compared to sibling donors. We compared outcomes for 105 patients aged 16 to 59 years undergoing URD transplants for acute myelogenous leukemia (AML) who were reported to the Australasian Bone Marrow Transplant Recipient Registry between 1992 and 2002, and a strictly selected matching set of 105 HLA-matched sibling donor (MSD) transplants. There was no significant difference between URD and MSD controls in the distributions of time from diagnosis to transplant, donor-recipient sex match, prior therapies, donor age, or performance status. The median follow-up of live URD patients was 4.4 years and for live MSD controls was 6.3 years. There were 18 good risk (complete remission [CR]1) and 87 poor risk (>CR1) recipients in both URD and sibling groups. Five-year disease-free survival (DFS) was not significantly different for good-risk URD and sibling donor recipients (62% versus 40%, P = .2), or poor-risk URD and sibling recipients (21% versus 25%, P = .2). In a stratified multivariate Cox regression model, the independent adverse risk factors for DFS were recipient cytomegalovirus positivity (P = .01) and the interaction of URD and earlier year of transplant (P = .006). Both neutrophil and platelet engraftment were significantly more rapid in the sibling group, but transplant-related mortality at 100 days was not significantly different. There was no difference in the cumulative incidence of acute graft-versus-host disease grade II or above at 100 days. Relapse occurred in 28% of good risk URD subjects and 16% of siblings (P = .3), and in poor risk subjects 39% and 29%, respectively (P = .2). Based on this data, URD allografts should be considered in AML patients without a matched sibling donor. This study provides a rationale for a larger prospective study of risk factors in allogeneic transplantation for AML and a guide on the subset of patients who may most benefit from an unrelated donor allograft in AML.
近期研究表明，在慢性粒细胞白血病中，非血缘供者（URD）干细胞移植与同胞供者移植的生存结果相当。我们比较了1992年至2002年间向澳大利亚骨髓移植受者登记处报告的105例年龄在16至59岁之间接受URD移植治疗急性髓性白血病（AML）患者的结局，以及严格挑选的105例HLA匹配的同胞供者（MSD）移植的匹配组。在从诊断到移植的时间分布、供受者性别匹配、既往治疗、供者年龄或体能状态方面，URD组与MSD对照组之间没有显著差异。存活的URD患者的中位随访时间为4.4年，存活的MSD对照组为6.3年。URD组和同胞组中均有18例低危（完全缓解[CR]1）和87例高危（>CR1）受者。低危URD和同胞供者受者的5年无病生存率（DFS）无显著差异（62%对40%，P = 0.2），高危URD和同胞受者也无显著差异（21%对25%，P = 0.2）。在分层多变量Cox回归模型中，DFS的独立不良危险因素是受者巨细胞病毒阳性（P = 0.01）以及URD与移植年份较早之间的相互作用（P = 0.006）。同胞组中性粒细胞和血小板植入均明显更快，但100天时的移植相关死亡率无显著差异。100天时II级或以上急性移植物抗宿主病的累积发生率没有差异。低危URD受试者中有28%复发，同胞中有16%复发（P = 0.3），高危受试者中分别为39%和29%（P = 0.2）。基于这些数据，对于没有匹配同胞供者的AML患者应考虑进行URD同种异体移植。本研究为对AML异基因移植危险因素进行更大规模的前瞻性研究提供了理论依据，并为可能最受益于AML非血缘供者同种异体移植的患者亚组提供了指导。
