Sun Guangyu, Sun Zimin, Liu Huilan, Zheng Changcheng, Tang Baolin, Zhu Xiaoyu, Song Kaidi
Department of Hematology, Affiliated Provincial Hospital, Anhui Medical University, Hefei 230001, China.
Zhonghua Xue Ye Xue Za Zhi. 2014 Aug;35(8):678-83. doi: 10.3760/cma.j.issn.0253-2727.2014.08.002.
To retrospectively study the impact of human leukocyte antigen (HLA) mtyping mismatching between donor and recipient on outcome of single unit unrelated cord blood transplantation (sUCBT).
139 patients with hematological malignancies received sUCBT in single center from May 2008 to August 2012 were analyzed. Of 139 patients at enrollment, 22 were 0 mismatched (mm), 69 1 mm, 48 2 mm by low-resolution HLA-A, -B, and high-resolution (HR) DRB1. All patients'conditioning regimen was myeloablative, and a combination of cyclosporine A (CsA) and mycophenolate mofetil (MMF) was given for graft-versus-host disease (GVHD) prophylaxis for all patients. The cohort of patients were followed-up until December 15, 2013.
Patients of 0 mm had a statistically significant higher cumulative incidence of neutrophil engraftment by day 42 than those of 1 and 2 mm (P=0.042 and 0.002, respectively), patients of 0 mm with either a higher prefreeze total nucleated cell (TNC) dose (>5 × 10⁷/kg) or lower dose (<5 × 10⁷/kg) had a statistically significant higher cumulative incidence of neutrophil engraftment by day 42 than those of 2 mm (P=0.01 and 0.02, respectively). Patients of 0 mm had a statistically significant lower cumulative incidence of acute GVHD by day 100 than those of 1 and 2 mm (P=0.006 and 0.001, respectively). The difference of 1-year transplant-related mortality (TRM) between 0 and 2 mm patients was statistically significant (P=0.03). Patients of 2 mm received UCB units with a TNC dose less than 5 × 10⁷/kg had a higher 1-year TRM than of 0 mm patients (P=0.03). Patients of 0 mm had a statistically significant higher 3-year disease free survival (DFS) than those of 2 mm (P=0.03), compared with patients of 2 mm given CB units with a TNC dose less than 5 × 10⁷/kg, 0 mm patients and 1mm patients received UCB units with a TNC dose greater than 4 × 10⁷/kg had higher DFS rates (P=0.02 and 0.02, respectively).
The HLA typing mismatching between donor and recipient had a great impact on neutrophil engraftment and long term DFS after sUCBT, 2mm cord blood unit with less TNC (<5 × 10⁷/kg) was not an optimum UCB graft.
回顾性研究供者与受者之间人类白细胞抗原（HLA）配型不匹配对单单位非血缘脐血移植（sUCBT）结局的影响。
分析2008年5月至2012年8月在单中心接受sUCBT的139例血液系统恶性肿瘤患者。139例入组患者中，低分辨HLA - A、 - B及高分辨（HR）DRB1配型0个错配（mm）的有22例，1个mm的有69例，2个mm的有48例。所有患者的预处理方案均为清髓性，所有患者均给予环孢素A（CsA）和霉酚酸酯（MMF）联合预防移植物抗宿主病（GVHD）。对该队列患者随访至2013年12月15日。
0个mm的患者在第42天时中性粒细胞植入的累积发生率显著高于1个mm和2个mm的患者（分别为P = 0.042和0.002），0个mm且冻前总核细胞（TNC）剂量较高（>5×10⁷/kg）或较低剂量（<5×10⁷/kg）的患者在第42天时中性粒细胞植入的累积发生率显著高于2个mm的患者（分别为P = 0.01和0.02）。0个mm的患者在第100天时急性GVHD的累积发生率显著低于1个mm和2个mm的患者（分别为P = 0.006和0.001）。0个mm和2个mm患者之间1年移植相关死亡率（TRM）的差异具有统计学意义（P = 0.03）。接受TNC剂量小于5×10⁷/kg脐血单位的2个mm患者1年TRM高于0个mm的患者（P = 0.03）。0个mm的患者3年无病生存率（DFS）显著高于2个mm的患者（P = 0.03），与接受TNC剂量小于5×10⁷/kg脐血单位的2个mm患者相比，接受TNC剂量大于4×10⁷/kg脐血单位的0个mm患者和1个mm患者DFS率更高（分别为P = 0.02和0.02）。
供者与受者之间的HLA配型不匹配对sUCBT后的中性粒细胞植入和长期DFS有很大影响，TNC较少（<5×10⁷/kg）的2个mm脐血单位不是最佳的脐血移植物。
