用于患有血液系统恶性肿瘤的成人进行异基因造血细胞移植的不匹配相关和不相关供体
Mismatched related and unrelated donors for allogeneic hematopoietic cell transplantation for adults with hematologic malignancies.
作者信息
Eapen Mary, O'Donnell Paul, Brunstein Claudio G, Wu Juan, Barowski Kate, Mendizabal Adam, Fuchs Ephraim J
机构信息
Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington.
出版信息
Biol Blood Marrow Transplant. 2014 Oct;20(10):1485-92. doi: 10.1016/j.bbmt.2014.05.015. Epub 2014 May 23.
Abstract
Two parallel phase II trials in adults with hematologic malignancies demonstrated comparable survival after reduced-intensity conditioning and transplantation of either 2 HLA-mismatched umbilical cord blood (UCB) units or bone marrow from HLA-haploidentical relatives. Donor choice is often subject to physician practice and institutional preference. Despite clear preliminary evidence of equipoise between HLA-haploidentical related donor and double unrelated donor UCB transplantation, the actual prospect of being randomized between these 2 very different donor sources is daunting to patients and their treating physicians alike. Under these circumstances, it is challenging to conduct a phase III randomized trial in which patients are assigned to the UCB or haploidentical bone marrow arms. Therefore, we aimed to provide an evidence-based review and recommendations for selecting donors for adults without an HLA-matched sibling or an HLA-matched adult unrelated donor.
摘要
两项针对患有血液系统恶性肿瘤的成人患者的平行II期试验表明，在进行强度降低的预处理以及移植2个HLA配型不合的脐带血（UCB）单位或来自HLA单倍型相同亲属的骨髓后，患者的生存率相当。供体的选择通常取决于医生的执业习惯和机构偏好。尽管有明确的初步证据表明HLA单倍型相同的相关供体与双份不相关供体UCB移植之间存在平衡，但在这两种截然不同的供体来源之间进行随机分组的实际前景，对患者及其主治医生来说都是令人生畏的。在这种情况下，开展一项III期随机试验，将患者分配到UCB组或单倍型相同骨髓组，具有挑战性。因此，我们旨在为没有HLA匹配同胞或HLA匹配成人无关供体的成年人选择供体提供基于证据的综述和建议。
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