Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
Biol Blood Marrow Transplant. 2012 Jun;18(6):903-12. doi: 10.1016/j.bbmt.2011.10.040. Epub 2011 Nov 4.
The relationship of race/ethnicity with outcomes of umbilical cord blood transplantation (UCBT) is not well known. We analyzed the association between race/ethnicity and outcomes of unrelated single UCBT for leukemia and myelodysplastic syndromes. Our retrospective cohort study consisted of 885 adults and children (612 whites, 145 blacks, and 128 Hispanics) who received unrelated single UCBT for leukemia and myelodysplastic syndromes between 1995 and 2006 and were reported to the Center for International Blood and Marrow Transplant Research. A 5-6/6 HLA-matched unit with a total nucleated cell count infused of ≥2.5 × 10(7)/kg was given to 40% white and 42% Hispanic, but only 21% black patients. Overall survival at 2 years was 44% for whites, 34% for blacks, and 46% for Hispanics (P = .008). In multivariate analysis adjusting for patient, disease, and treatment factors (including HLA match and cell dose), blacks had inferior overall survival (relative risk of death, 1.31; P = .02), whereas overall survival of Hispanics was similar (relative risk, 1.03; P = .81) to that of whites. For all patients, younger age, early-stage disease, use of units with higher cell dose, and performance status ≥80 were independent predictors of improved survival. Black patients and white patients infused with well-matched cords had comparable survival; similarly, black and white patients receiving units with adequate cell dose had similar survival. These results suggest that blacks have inferior survival to whites after single UCBT, but outcomes are improved when units with a higher cell dose are used.
种族/民族与脐带血移植（UCBT）结果的关系尚不清楚。我们分析了种族/民族与无关单份 UCBT 治疗白血病和骨髓增生异常综合征结果之间的关系。我们的回顾性队列研究包括 1995 年至 2006 年间接受无关单份 UCBT 治疗白血病和骨髓增生异常综合征的 885 名成人和儿童（612 名白人，145 名黑人，128 名西班牙裔），并向国际血液和骨髓移植研究中心报告。40%的白人患者和 42%的西班牙裔患者接受了 5-6/6 HLA 匹配单位，且输注的总核细胞数≥2.5×10(7)/kg，但只有 21%的黑人患者接受了这种治疗。白人患者的 2 年总生存率为 44%，黑人患者为 34%，西班牙裔患者为 46%（P=0.008）。在调整患者、疾病和治疗因素（包括 HLA 匹配和细胞剂量）的多变量分析中，黑人的总体生存率较差（死亡风险比，1.31；P=0.02），而西班牙裔的总体生存率与白人相似（风险比，1.03；P=0.81）。对于所有患者，年龄较小、疾病早期、使用细胞剂量较高的单位和表现状态≥80 是生存改善的独立预测因素。输注匹配良好脐带的黑人和白人患者的生存情况相当；同样，接受足够细胞剂量单位的黑人和白人患者的生存情况也相似。这些结果表明，黑人在接受单份 UCBT 后生存率低于白人，但使用高细胞剂量的单位可以改善预后。
