对于没有 HLA 匹配同胞供体的 AML/MDS 老年患者，采用减低强度的造血细胞移植，脐带血是一种可行的选择。
Reduced-intensity hematopoietic cell transplantation in older patients with AML/MDS: umbilical cord blood is a feasible option for patients without HLA-matched sibling donors.
机构信息
Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN 55455, USA.
出版信息
Bone Marrow Transplant. 2012 Apr;47(4):494-8. doi: 10.1038/bmt.2011.114. Epub 2011 May 23.
Abstract
Umbilical cord blood (UCB) has increased access to hematopoietic cell transplantation (HCT) for patients without HLA-matched sibling donors (MSD). We compared outcomes of HCT using MSD (N=38) or UCB (N=60) among older patients (age ≥ 55 years) with AML or myelodysplastic syndromes (MDS). All patients received a reduced intensity regimen consisting of CY, fludarabine and 200 cGy TBI. Median age at HCT was 63 years for MSD and 61 years for UCB recipients. Among UCB recipients, 95% received two UCB units and 88% received 1-2 locus HLA-mismatched units to optimize cell dose. OS at 3-years was 37% for MSD and 31% for UCB recipients (P=0.21). On multivariate analysis, donor source (MSD vs UCB) did not impact risks of OS, leukemia-free survival and relapse or treatment-related mortality. UCB is feasible as an alternative donor source for reduced-intensity conditioning HCT among older patients with AML and MDS who do not have a suitable MSD.
摘要
脐带血 (UCB) 为没有 HLA 匹配同胞供体 (MSD) 的患者提供了更多接受造血细胞移植 (HCT) 的机会。我们比较了年龄≥55 岁的 AML 或骨髓增生异常综合征 (MDS) 患者接受 MSD (N=38) 或 UCB (N=60) 作为供体来源的 HCT 结果。所有患者均接受包含环磷酰胺、氟达拉滨和 200cGy TBI 的低强度方案治疗。MSD 和 UCB 受者的 HCT 中位年龄分别为 63 岁和 61 岁。在 UCB 受者中，95%的患者接受了两个 UCB 单位，88%的患者接受了 1-2 个 HLA 错配单位，以优化细胞剂量。MSD 和 UCB 受者的 3 年 OS 分别为 37%和 31%（P=0.21）。多因素分析显示，供体来源（MSD 与 UCB）并不影响 OS、无白血病生存、复发或治疗相关死亡率的风险。对于没有合适 MSD 的年龄较大的 AML 和 MDS 患者，UCB 作为低强度预处理 HCT 的替代供体来源是可行的。
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