Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Leukemia. 2013 Mar;27(3):604-9. doi: 10.1038/leu.2012.210. Epub 2012 Jul 23.
We investigated whether a young human leukocyte antigen (HLA)-matched unrelated donor (MUD) should be preferred as donor to an HLA-identical sibling (MRD) for older patients with myelodysplastic syndrome (MDS) (≥ 50 years) who underwent allogeneic stem cell transplantation (AHSCT). Outcomes of 719 MDS patients with a median age of 58 years (range, 50-73 years) who received AHSCT from related (n=555) or unrelated (n=164) donors between 1999 and 2008 and reported to the European Group for Blood and Marrow Transplantation were analyzed. The median donor age of the MRD was 56 years (range: 35-78), in contrast to 34 years (range: 19-64) for the MUDs. Influence of donor's age on survival was not observed for MRD (hazard ratio (HR): 1.01 (95% confidence interval (CI): 0.99-1.02), P=0.2), but there was a significant impact of MUD's age on outcome (HR: 1.03 (95% CI: 1.01-1.06); P=0.02). Transplantation from younger MUDs (<30 years) had a significant improved 5-year overall survival in comparison with MRD and older MUDs (>30 years): 40% vs 33% vs 24% (P=0.04). In a multivariate analysis, AHSCT from young MUD (<30 years) remained a significant factor for improved survival in comparison with MRD (HR: 0.65 (95% CI: 0.45-0.95), P=0.03), which should be considered in donor selection for older patients.
我们研究了对于接受异基因造血干细胞移植（AHSCT）的年龄较大（≥50 岁）骨髓增生异常综合征（MDS）患者，是否应该优先选择年轻的人类白细胞抗原（HLA）匹配的无关供者（MUD）作为供者，而非 HLA 完全匹配的同胞供者（MRD）。我们分析了 1999 年至 2008 年间，欧洲血液和骨髓移植组报告的 719 例 MDS 患者的结果，这些患者中位年龄为 58 岁（范围，50-73 岁），接受来自相关供者（n=555）或无关供者（n=164）的 AHSCT。MRD 的供者年龄中位数为 56 岁（范围：35-78），而 MUD 为 34 岁（范围：19-64）。MRD 的供者年龄对生存没有影响（危险比（HR）：1.01（95%置信区间（CI）：0.99-1.02），P=0.2），但 MUD 的年龄对结果有显著影响（HR：1.03（95% CI：1.01-1.06）；P=0.02）。与 MRD 和年龄较大的 MUD（>30 岁）相比，来自年轻 MUD（<30 岁）的移植有显著改善的 5 年总生存率：40%比 33%比 24%（P=0.04）。在多变量分析中，与 MRD 相比，来自年轻 MUD（<30 岁）的 AHSCT 仍然是提高生存的显著因素（HR：0.65（95% CI：0.45-0.95），P=0.03），在为老年患者选择供者时应考虑这一点。
