Malard Florent, Chevallier Patrice, Guillaume Thierry, Delaunay Jacques, Rialland Fanny, Harousseau Jean-Luc, Moreau Philippe, Mechinaud Francoise, Milpied Noel, Mohty Mohamad
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France; CRNCA UMR 892 INSERM -6299 CNRS, Nantes, France.
Service d'Hématologie Clinique, CHU and Université de Nantes, Nantes, France.
Biol Blood Marrow Transplant. 2014 Aug;20(8):1217-23. doi: 10.1016/j.bbmt.2014.04.021. Epub 2014 Apr 23.
This study analyzed changes in patients, transplantation, graft characteristics, and outcome among 827 patients who received their first allo-SCT in a single center between 1983 and 2010. In the 2001 to 2010 decade, compared with the 1983 to 1990 and 1991 to 2000 decades, patients were significantly older and presented with higher risk diseases, reduced intensity conditioning and alternative donors were used more often, and stem cell sources changed from bone marrow to peripheral blood stem cells and cord blood. In the 2001 to 2010 decade, we observed a significant decrease in nonrelapse mortality (NRM) (P = .0007 and P < .0001, respectively) and an increase in relapse incidence (P = .04 and P = .009, respectively), but overall survival (OS) was increased (P = .11 and P = .009, respectively), and there was a trend towards an increased progression-free survival (P = .30 and P = .09, respectively), as compared with the 1983 to 1990 and 1991 to 2000 decades. Chronic graft-versus-host disease (GVHD) was significantly increased, whereas grades III to IV acute GVHD remained stable. These data suggest that, despite the fact that older and higher risk patients with more comorbidities underwent transplantation in the last 10 years, NRM decreased while the incidence of relapse increased and the OS improved.
本研究分析了1983年至2010年间在单一中心接受首次异基因造血干细胞移植（allo-SCT）的827例患者的患者情况、移植情况、移植物特征及预后变化。在2001年至2010年这十年间，与1983年至1990年以及1991年至2000年这两个十年相比，患者年龄显著增大，所患疾病风险更高，采用减低强度预处理和使用替代供者的情况更为常见，并且干细胞来源从骨髓转变为外周血干细胞和脐带血。在2001年至2010年这十年间，我们观察到非复发死亡率（NRM）显著降低（分别为P = .0007和P < .0001），复发率升高（分别为P = .04和P = .009），但总生存期（OS）有所增加（分别为P = .11和P = .009），并且无进展生存期有增加趋势（分别为P = .30和P = .09），与1983年至1990年以及1991年至2000年这两个十年相比。慢性移植物抗宿主病（GVHD）显著增加，而III至IV级急性GVHD保持稳定。这些数据表明，尽管在过去十年中年龄较大且合并症更多的高风险患者接受了移植，但NRM降低，而复发率升高，且OS得到改善。
