Eurocord, Hôpital Saint-Louis, 1 ave Claude Vellefaux, Quadrilatère porte 5, Paris cedex 10, France.
Blood. 2010 Sep 16;116(11):1849-56. doi: 10.1182/blood-2010-02-271692. Epub 2010 Jun 10.
We analyzed risk factors influencing outcomes after related (R) human leukocyte antigen-identical cord blood transplantation (CBT) for 147 patients with malignancies reported to Eurocord-European Group for Blood and Marrow Transplantation. CBT has been performed since 1990; median follow-up was 6.7 years. Median patient age was 5 years. Acute leukemia was the most frequent diagnosis (74%). At CBT, 40 patients had early, 70 intermediate, and 37 advanced disease. CB grafts contained a median of 4.1 × 10(7)/kg total nucleated cells (TNCs) after thawing. The cumulative incidence (CI) of neutrophil recovery was 90% at day +60. CIs of acute and chronic graft-versus-host disease (GVHD) were 12% and 10% at 2 years, respectively. At 5 years, CIs of nonrelapse mortality and relapse were 9% and 47%, respectively; the probability of disease-free survival (DFS) and overall survival were 44% and 55%, respectively. Among other factors, higher TNCs infused was associated with rapid neutrophil recovery and improved DFS. The use of methotrexate as GVHD prophylaxis decreased the CI of engraftment. Patients without advanced disease had improved DFS. These results support banking and use of CB units for RCBT. Cell dose, GVHD prophylaxis not including methotrexate, and disease status are important factors for outcomes after RCBT.
我们分析了 147 例恶性肿瘤患者相关人白细胞抗原（HLA）匹配的脐血移植（CBT）后结局的影响因素，这些患者的资料由欧洲脐带血移植协作组（Eurocord-European Group for Blood and Marrow Transplantation）报告。CBT 自 1990 年开始实施；中位随访时间为 6.7 年。中位患者年龄为 5 岁。急性白血病是最常见的诊断（74%）。在 CBT 时，40 例患者处于早期，70 例患者处于中期，37 例患者处于晚期疾病状态。解冻后 CB 移植物中含有中位数为 4.1×10(7)/kg 的总核细胞（TNC）。中性粒细胞恢复的累积发生率（CI）在+60 天时为 90%。急性和慢性移植物抗宿主病（GVHD）的 2 年 CI 分别为 12%和 10%。5 年时，非复发死亡率和复发的 CI 分别为 9%和 47%；无病生存率（DFS）和总生存率分别为 44%和 55%。在其他因素中，输注的 TNC 越高，中性粒细胞恢复越快，DFS 越好。使用甲氨蝶呤作为 GVHD 预防可降低植入的 CI。无晚期疾病的患者 DFS 更好。这些结果支持为 RCBT 储存和使用 CB 单位。细胞剂量、不包括甲氨蝶呤的 GVHD 预防和疾病状态是 RCBT 后结局的重要因素。
