Department of Pediatrics, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Gwangju, Korea.
J Korean Med Sci. 2011 Dec;26(12):1548-55. doi: 10.3346/jkms.2011.26.12.1548. Epub 2011 Nov 29.
Aim of this study was to compare the outcomes of transplantation by donor source and to help select the best alternative donor in children with leukemia. Donor sources included matched related donor (MRD, n = 35), allele-matched unrelated donor (M-UD, n = 10) or -mismatched (MM)-UD (n = 13) or unrelated umbilical cord blood (UCB, n = 11). UCB group had a significantly higher incidence of grade II-IV acute graft versus host disease (MRD, 11.8%; M-UD, 30.0%; MM-UD, 15.4%, UCB, 54.4%, P = 0.004) but there was no difference in incidence of chronic graft versus host disease between 4 groups. The 5-yr leukemia-free survival (LFS) was 76.7%, 60.0%, 69.2%, and 45.5%, respectively (P = 0.128). MRD group showed higher LFS rate than UCB group (P = 0.022). However, LFS of M-UD and MM-UD together (65.2%) was not different from that of MRD group (76.7%, P = 0.325), or from that of UCB (45.5%, P = 0.190). The relapse incidence at 5 yr was 17.1%, 20.0%, 15.4%, and 0%, respectively (P = 0.460). The 100-day treatment-related mortality was 2.9%, 20.0%, 7.7%, and 36.4%, respectively (P = 0.011). Despite the limitations of small number of patients, unrelated donor transplants including even allele-mismatched ones, seem to be as effective in children with leukemia lacking suitable relative donors. Also, UCB transplant may serve as another possible option in urgent transplants.
本研究旨在比较不同供者来源的移植结果，并帮助选择儿童白血病的最佳替代供者。供者来源包括匹配的亲缘供者（MRD，n = 35）、匹配不全的亲缘供者（M-UD，n = 10）或不匹配的亲缘供者（MM-UD，n = 13）或无关脐带血（UCB，n = 11）。UCB 组发生 2-4 级急性移植物抗宿主病的发生率明显较高（MRD 组为 11.8%，M-UD 组为 30.0%，MM-UD 组为 15.4%，UCB 组为 54.4%，P = 0.004），但 4 组间慢性移植物抗宿主病的发生率无差异。5 年无白血病生存率（LFS）分别为 76.7%、60.0%、69.2%和 45.5%（P = 0.128）。MRD 组的 LFS 率高于 UCB 组（P = 0.022）。然而，M-UD 和 MM-UD 联合组（65.2%）的 LFS 率与 MRD 组（76.7%，P = 0.325）或 UCB 组（45.5%，P = 0.190）无差异。5 年复发率分别为 17.1%、20.0%、15.4%和 0%（P = 0.460）。100 天治疗相关死亡率分别为 2.9%、20.0%、7.7%和 36.4%（P = 0.011）。尽管患者数量较少存在局限性，但包括匹配不全的亲缘供者在内的无关供者移植在缺乏合适亲缘供者的白血病患儿中似乎同样有效。此外，在紧急移植中，UCB 移植可能是另一种可行的选择。
