Viollier R, Socié G, Tichelli A, Bacigalupo A, Korthof E T, Marsh J, Cornish J, Ljungman P, Oneto R, Békássy A N, Fuehrer M, Maury S, Schrezenmeier H, van Lint M T, Wojcik D, Locasciulli A, Passweg J R
Universitätskliniken Basel, Basel, Switzerland.
Bone Marrow Transplant. 2008 Jan;41(1):45-50. doi: 10.1038/sj.bmt.1705894. Epub 2007 Nov 5.
The aim was to determine whether outcome of unrelated donor transplantation for severe aplastic anemia has improved in recent years and whether this is due to patient selection or better transplant technology. We analyzed 498 patients transplanted during 1990-2005. By running univariate regression models dichotomizing year of transplantation we defined 1998 as the year of the most significant change in survival. Five-year survival increased from 32+/-8% before 1998 to 57+/-8% after 1998 (P<0.0001). When comparing the cohort before (n=149) and after 1998 (n=349), there were no differences except for older age, and more frequent use of PBSCs, after 1998. High-resolution HLA typing data were unavailable. After 1998, there was less graft failure (11 vs 26%, P<0.0001), less acute GvHD (cumulative incidence 28 vs 37%, P=0.02) and less chronic GvHD (22 vs 38%, P=0.004). In multivariate analyses adjusting for differences in age, HLA-mismatch, performance score and time to transplantation, there was no change in the year of transplant effect (relative risk of death in transplants after 1998: 0.44 (95% confidence interval 0.33-0.59)). There is no evidence for patient selection to explain significantly improved survival in patients transplanted after 1998. We speculate that this is due to better donor matching.
目的是确定近年来严重再生障碍性贫血无关供者移植的结局是否有所改善，以及这是否归因于患者选择或更好的移植技术。我们分析了1990年至2005年期间接受移植的498例患者。通过运行将移植年份二分的单变量回归模型，我们将1998年定义为生存率发生最显著变化的年份。五年生存率从1998年前的32±8%提高到1998年后的57±8%（P<0.0001）。比较1998年前（n=149）和1998年后（n=349）的队列，除了1998年后年龄较大和更频繁使用外周血干细胞外，没有其他差异。高分辨率HLA分型数据不可用。1998年后，移植物失败较少（11%对26%，P<0.0001），急性移植物抗宿主病较少（累积发病率28%对37%，P=0.02），慢性移植物抗宿主病较少（22%对38%，P=0.004）。在对年龄、HLA错配、性能评分和移植时间差异进行调整的多变量分析中，移植年份效应没有变化（1998年后移植死亡的相对风险：0.44（95%置信区间0.33 - 0.59））。没有证据表明患者选择可以解释1998年后移植患者生存率的显著提高。我们推测这是由于更好的供者匹配。
