Mielcarek Marco, Storer Barry E, Sandmaier Brenda M, Sorror Mohamed L, Maloney David G, Petersdorf Effie, Martin Paul J, Storb Rainer
Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109-1024, USA.
Biol Blood Marrow Transplant. 2007 Dec;13(12):1499-507. doi: 10.1016/j.bbmt.2007.09.004.
We sought to determine whether patients with hematologic malignancies treated by nonmyeloablative hematopoietic cell transplantation (HCT) at a single institution between December 1997 and June 2006 had worse outcomes with grafts from unrelated donors (URDs) (n = 184) compared with HLA-identical related donors (n = 221). The nonmyeloablative preparative regimen consisted of 2 Gy of total body irradiation (TBI) with (78%) or without (22%) fludarabine, along with posttransplantation mycophenolate mofetil (MMF) and cyclosporine (CSa). After adjusting for the HCT comorbidity index, relapse risk, patient age, stem cell source, preparative regimen, previous cytomegalovirus (CMV) infection, and sex mismatch of donor and recipient in multivariate analysis, we found no statistically significant differences between unrelated and related HCT recipients in terms of risk of nonrelapse mortality (NRM; hazard ratio [HR] = 0.98; 95% confidence interval = 0.6-1.6; P = .94), relapse (HR = 1.04; 95% confidence interval = 0.7-1.5; P = .82), or overall mortality (HR = 0.99; 95% confidence interval = 0.7-1.4; P = .94). Overall rates of severe acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) also were not significantly different between the 2 groups. We conclude that within the limitations of a retrospective study, these results indicate that candidates for nonmyeloablative HCT without suitable related donors may expect similar outcomes with grafts from URDs.
我们试图确定，1997年12月至2006年6月期间在单一机构接受非清髓性造血细胞移植（HCT）的血液系统恶性肿瘤患者，与接受人类白细胞抗原（HLA）匹配的亲属供者移植（n = 221）相比，接受非亲属供者（URD）移植（n = 184）的预后是否更差。非清髓性预处理方案包括2 Gy全身照射（TBI），联合（78%）或不联合（22%）氟达拉滨，以及移植后使用霉酚酸酯（MMF）和环孢素（CsA）。在多变量分析中，对HCT合并症指数、复发风险、患者年龄、干细胞来源、预处理方案、既往巨细胞病毒（CMV）感染以及供受者性别不匹配进行校正后，我们发现非亲属和亲属HCT受者在非复发死亡率（NRM；风险比[HR] = 0.98；95%置信区间 = 0.6 - 1.6；P = 0.94）、复发率（HR = 1.04；95%置信区间 = 0.7 - 1.5；P = 0.82）或总死亡率（HR = 0.99；95%置信区间 = 0.7 - 1.4；P = 0.94）方面没有统计学显著差异。两组间严重急性和广泛慢性移植物抗宿主病（aGVHD、cGVHD）的总体发生率也没有显著差异。我们得出结论，在回顾性研究的局限性内，这些结果表明，对于没有合适亲属供者的非清髓性HCT候选者，接受URD移植可能会有相似的预后。
