Sanz Jaime, Wagner John E, Sanz Miguel A, DeFor Todd, Montesinos Pau, Bachanova Veronika, Lorenzo Ignacio, Warlick Erica, Sanz Guillermo F, Brunstein Claudio
Department of Hematology, Hospital Universitari y Politècnic La Fe, Valencia, Spain.
Biol Blood Marrow Transplant. 2013 Dec;19(12):1725-30. doi: 10.1016/j.bbmt.2013.09.015. Epub 2013 Sep 30.
We compared the clinical outcomes of adults with acute leukemia that received single-unit umbilical cord blood transplantation (sUCBT) after conditioning with a busulfan/antithymocyte globulin (BU-ATG)-based regimen at University Hospital La Fe (n = 102) or double-unit UCBT (dUCBT) after conditioning with a total body irradiation (TBI)-based regimen at the University of Minnesota (n = 91). Nonrelapse mortality, relapse and disease-free survival were similar in the 2 groups. Multivariate analyses, showed more rapid neutrophil (hazard ratio [HR], .6; 95% confidence interval [CI], .45 to .80; P = .0006) and platelet recovery (HR, .59; 95% CI, .43 to.83; P = .002) after the BU-ATG-based conditioning and sUCBT. Although there was a lower risk of acute graft-versus-host disease (GVHD) grade II to IV (HR, 2.81; 95% CI, 1.75 to 4.35; P < .001) after BU-ATG and sUCBT, the incidences of grade III to IV acute and chronic GVHD were similar between the 2 groups. Regarding disease-specific outcomes, disease-free survival in both acute myeloid leukemia and acute lymphoblastic leukemia (ALL) patients were not significantly different; however, a significantly lower relapse rate was found in patients with ALL treated with TBI and dUCBT (HR, .3; 95% CI, .12 to .84; P = .02). In the context of these specific treatment platforms, our study demonstrates that sUCB and dUCBT offer similar outcomes.
我们比较了在拉费大学医院接受基于白消安/抗胸腺细胞球蛋白（BU-ATG）方案预处理的单单位脐带血移植（sUCBT）的成年急性白血病患者（n = 102）与在明尼苏达大学接受基于全身照射（TBI）方案预处理的双单位脐带血移植（dUCBT）的成年急性白血病患者（n = 91）的临床结局。两组的非复发死亡率、复发率和无病生存率相似。多变量分析显示，基于BU-ATG的预处理和sUCBT后中性粒细胞恢复更快（风险比[HR]，0.6；95%置信区间[CI]，0.45至0.80；P = 0.0006），血小板恢复也更快（HR，0.59；95%CI，0.43至0.83；P = 0.002）。虽然基于BU-ATG的预处理和sUCBT后发生II至IV级急性移植物抗宿主病（GVHD）的风险较低（HR，2.81；95%CI，1.75至4.35；P < 0.001），但两组III至IV级急性和慢性GVHD的发生率相似。关于疾病特异性结局，急性髓系白血病和急性淋巴细胞白血病（ALL）患者的无病生存率无显著差异；然而，接受TBI和dUCBT治疗的ALL患者的复发率显著较低（HR，0.3；95%CI，0.12至0.84；P = 0.02）。在这些特定治疗平台的背景下，我们的研究表明，sUCB和dUCBT的结局相似。
