对于一名患有急性白血病的男性患者而言，谁是最佳的造血干细胞供者？
Who is the best hematopoietic stem-cell donor for a male patient with acute leukemia?
作者信息
Ringdén Olle, Labopin Myriam, Solders Martin, Beelen Dietrich, Arnold Renate, Ehninger Gerhard, Milpied Noel, Niederwieser Dietger, Hamladji Rose-Marie, Kyrcz-Krzemien Slawomira, Ganser Arnold, Socié Gerard, Stelljes Matthias, Volin Liisa, Craddock Charles, Mohty Mohamad
机构信息
1 Center for Allogeneic Stem Cell Transplantation and Division of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. 2 Department of Haematology, Hôpital Saint Antoine, Paris, France. 3 Department of Bone Marrow Transplantation, Essen, University Hospital, Essen, Germany. 4 Medizinische Klinik m. S. Hämatologie/Onkologie, Charité Universitätsmedizin, Berlin, Germany. 5 Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany. 6 CHU Bordeaux, Hôpital Haut-leveque, Pessac, France. 7 Division of Hematology, Oncology and Hemostasiology, University Hospital Leipzig, Leipzig, Germany. 8 Service Hématologie Greffe de Moelle, Centre Pierre et Marie Curie, Alger, Algeria. 9 Department of Hematology and BMT, Silesian Medical Academy, Katowice, Poland. 10 Department of Hematology/Oncology, Hannover Medical University, Hannover, Germany. 11 Department of Hematology - BMT, Hôpital St. Louis, Paris, France. 12 Department of Hematology/Oncology, University of Münster, Münster, Germany. 13 Division of Hematology, Helsinki University Central Hospital, Helsinki, Finland. 14 Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom. 15 Address correspondence to: Olle Ringdén, M.D., Ph.D., Karolinska Institutet, Division of Therapeutic Immunology, Karolinska University Hospital Huddinge, F79, SE-141 86 Stockholm, Sweden.
出版信息
Transplantation. 2014 Sep 15;98(5):569-77. doi: 10.1097/TP.0000000000000102.
BACKGROUND
Female donors for male recipients worsen the outcome of allogeneic hematopoietic stem-cell transplantation. We wanted to find out whether a male human leukocyte antigen (HLA)-matched unrelated donor (MUD, 8/8, n=2,014) might be an alternative to a female HLA-identical sibling donor (n=2,656) for male patients with acute leukemia.
METHODS
This is a retrospective analysis from the Acute Leukaemia Working Party of the European Group for Blood and Marrow Transplantation.
RESULTS
The relative risk (RR) of acute graft-versus-host disease (GVHD) of grades II to IV was increased in the MUD group with acute myeloid leukemia (AML) (RR, 1.47; P<0.001) and acute lymphoblastic leukemia (ALL) (RR, 1.76; P<0.001). There was no difference in incidence of chronic GVHD and nonrelapse mortality between the two groups. Probability of relapse was lower in the MUD group than in the sibling group in patients with ALL (hazards ratio [HR], 0.75; P=0.04) but not in the AML patients (HR, 0.89; P=0.17). Survival was not different between the groups. Leukemia-free survival (LFS) was also similar in the sibling and MUD groups in patients with AML (HR, 1.01; P=0.81) or ALL (HR, 0.93; P=0.45). Factors significantly associated with reduced LFS included active disease, poor cytogenetics, age, year of hematopoietic stem-cell transplantation, reduced-intensity conditioning, and the use of antithymocyte globulin.
CONCLUSION
Male patients who received grafts from male MUDs demonstrated an increased incidence of acute GVHD and LFS same as when using HLA-identical female donors.
背景
女性供体对男性受体进行异基因造血干细胞移植会使移植结果变差。我们想了解对于患有急性白血病的男性患者，男性人类白细胞抗原（HLA）匹配的无关供体（MUD，8/8，n = 2014）是否可作为女性HLA相同的同胞供体（n = 2656）的替代选择。
方法
这是一项来自欧洲血液与骨髓移植组急性白血病工作组的回顾性分析。
结果
在急性髓系白血病（AML）（相对危险度[RR]，1.47；P<0.001）和急性淋巴细胞白血病（ALL）（RR，1.76；P<0.001）患者中，MUD组发生II至IV级急性移植物抗宿主病（GVHD）的相对危险度增加。两组慢性GVHD发生率和非复发死亡率无差异。ALL患者中，MUD组的复发概率低于同胞供体组（风险比[HR]，0.75；P = 0.04），但AML患者中并非如此（HR，0.89；P = 0.17）。两组生存率无差异。AML或ALL患者中，同胞供体组和MUD组的无白血病生存率（LFS）也相似（AML患者HR，1.01；P = 0.81；ALL患者HR，0.93；P = 0.45）。与LFS降低显著相关的因素包括疾病活动、细胞遗传学不良、年龄、造血干细胞移植年份、减低强度预处理以及抗胸腺细胞球蛋白的使用。
结论
接受男性MUD供体移植的男性患者急性GVHD发生率增加，且LFS与使用HLA相同的女性供体时相同。
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