Logan Aaron C, Wang Zhiyu, Alimoghaddam Kamran, Wong Ruby M, Lai Tze, Negrin Robert S, Grumet Carl, Logan Brent R, Zhang Mei-Jie, Spellman Stephen R, Lee Stephanie J, Miklos David B
Division of Hematology and Blood and Marrow Transplantation, Department of Medicine, University of California, San Francisco, San Francisco, California.
Health Research and Policy, Stanford University School of Medicine, Stanford, California.
Biol Blood Marrow Transplant. 2015 Apr;21(4):746-54. doi: 10.1016/j.bbmt.2014.12.036. Epub 2015 Jan 5.
We evaluated ABO associated outcomes in 1737 patients who underwent allogeneic hematopoietic cell transplantation (allo-HCT) at Stanford University between January 1986 and July 2011. Grafts were 61% ABO matched, 18% major mismatched (MM), 17% minor MM, and 4% bidirectional MM. Median follow-up was 6 years. In multivariate analysis, overall survival (OS) was inferior in minor MM hematopoietic cell transplantations (median 2.1 versus 6.3 years; hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.19 to 2.05; P = .001) in comparison with ABO-matched grafts. ABO minor MM was associated with an increase in early nonrelapse mortality (NRM) (18% versus 13%; HR, 1.48; 95% CI, 1.06 to 2.06; P = .02). In an independent Center for International Blood and Marrow Transplant Research (CIBMTR) analysis of 435 lymphoma patients receiving mobilized peripheral blood grafts, impairment of OS (HR, 1.55; 95% CI, 1.07 to 2.25; P = .021) and increased NRM (HR, 1.72; 95% CI, 1.11 to 2.68; P = .03) were observed in recipients of ABO minor-MM grafts. A second independent analysis of a CIBMTR data set including 5179 patients with acute myeloid leukemia and myelodysplastic syndrome identified a nonsignificant trend toward decreased OS in recipients of ABO minor-MM grafts and also found ABO major MM to be significantly associated with decreased OS (HR, 1.19; 95% CI, 1.08 to 1.31; P < .001) and increased NRM (HR, 1.23; 95% CI, 1.08 to 1.4; P = .002). ABO minor and major MM are risk factors for worse transplantation outcomes, although the associated hazards may not be uniform across different transplantation populations. Further study is warranted to determine which patient populations are at greatest risk, and whether this risk can be modified by anti-B cell therapy or other peri-transplantation treatments.
我们评估了1986年1月至2011年7月期间在斯坦福大学接受异基因造血细胞移植(allo-HCT)的1737例患者中与ABO血型相关的结局。移植物的ABO血型匹配率为61%,主要错配(MM)率为18%,次要MM率为17%,双向MM率为4%。中位随访时间为6年。在多变量分析中,与ABO血型匹配的移植物相比,次要MM造血细胞移植的总生存期(OS)较差(中位生存期分别为2.1年和6.3年;风险比[HR]为1.56;95%置信区间[CI]为1.19至2.05;P = 0.001)。ABO次要MM与早期非复发死亡率(NRM)增加相关(18%对13%;HR为1.48;95%CI为1.06至2.06;P = 0.02)。在国际血液和骨髓移植研究中心(CIBMTR)对435例接受动员外周血移植物的淋巴瘤患者进行的独立分析中,观察到ABO次要MM移植物受者的OS受损(HR为1.55;95%CI为1.07至2.25;P = 0.021)和NRM增加(HR为1.72;95%CI为1.11至2.68;P = 0.03)。对CIBMTR数据集进行的第二项独立分析,该数据集包括5179例急性髓系白血病和骨髓增生异常综合征患者,发现ABO次要MM移植物受者的OS有下降趋势但无统计学意义,同时还发现ABO主要MM与OS降低(HR为1.19;95%CI为1.08至1.31;P < 0.001)和NRM增加(HR为1.23;95%CI为1.08至1.4;P = 0.002)显著相关。ABO次要和主要MM是移植结局较差的危险因素,尽管不同移植人群的相关风险可能并不一致。有必要进一步研究以确定哪些患者群体风险最大,以及这种风险是否可以通过抗B细胞疗法或其他移植围手术期治疗来改善。