Yao W, Zheng C C, Liu H L, Geng L Q, Tang B L, Tong J, Zhu X Y, Song K D, Qiang P, Sun Z M
School of Medicine, Shandong University, Jinan, CN.
Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, CN.
Braz J Med Biol Res. 2015 Oct;48(10):871-6. doi: 10.1590/1414-431X20154389. Epub 2015 Mar 27.
Treatments for patients with hematologic malignancies not in remission are limited, but a few clinical studies have investigated the effects of salvaged unrelated cord blood transplantation (CBT). We retrospectively studied 19 patients with acute leukemia, 5 with myelodysplastic syndrome (MDS with refractory anemia with excess blasts [RAEB]), and 2 with non-Hodgkin's lymphoma who received 1 CBT unit ≤ 2 loci human leukocyte antigen (HLA)-mismatched after undergoing myeloablative conditioning regimens between July 2005 and July 2014. All of them were in non-remission before transplantation. The infused total nucleated cell (TNC) dose was 4.07 (range 2.76-6.02) × 10⁷/kg and that of CD34⁺ stem cells was 2.08 (range 0.99-8.65) × 10⁵/kg. All patients were engrafted with neutrophils that exceeded 0.5 × 10⁹/L on median day +17 (range 14-37 days) and had platelet counts of >20 × 10⁹/L on median day +35 (range 17-70 days). Sixteen patients (61.5%) experienced pre-engraftment syndrome (PES), and six (23.1%) patients progressed to acute graft-versus-host disease (GVHD). The cumulative incidence rates of II-IV acute GVHD and chronic GVHD were 50% and 26.9%, respectively. After a median follow-up of 27 months (range 5-74), 14 patients survived and 3 relapsed. The estimated 2-year overall survival (OS), disease-free survival (DFS), and non-relapse mortality (NRM) rates were 50.5%, 40.3%, and 35.2%, respectively. Salvaged CBT might be a promising modality for treating hematologic malignancies, even in patients with a high leukemia burden.
对于未缓解的血液系统恶性肿瘤患者，治疗方法有限，但有一些临床研究探讨了挽救性非亲属脐血移植（CBT）的效果。我们回顾性研究了2005年7月至2014年7月期间接受1个CBT单位、≤2个位点人类白细胞抗原（HLA）不匹配的清髓性预处理方案后的19例急性白血病患者、5例骨髓增生异常综合征（伴有过多原始细胞的难治性贫血[RAEB]的MDS）患者和2例非霍奇金淋巴瘤患者。他们在移植前均未缓解。输注的总核细胞（TNC）剂量为4.07（范围2.76 - 6.02）×10⁷/kg，CD34⁺干细胞剂量为2.08（范围0.99 - 8.65）×10⁵/kg。所有患者中性粒细胞在中位+17天（范围14 - 37天）超过0.5×10⁹/L实现植入，血小板计数在中位+35天（范围17 - 70天）>20×10⁹/L。16例患者（61.5%）发生植入前综合征（PES），6例（23.1%）患者进展为急性移植物抗宿主病（GVHD）。II - IV级急性GVHD和慢性GVHD的累积发生率分别为50%和26.9%。中位随访27个月（范围5 - 74）后，14例患者存活，3例复发。估计的2年总生存率（OS）、无病生存率（DFS）和非复发死亡率（NRM）分别为50.5%、40.3%和35.2%。挽救性CBT可能是治疗血液系统恶性肿瘤的一种有前景的方式，即使对于白血病负荷高的患者也是如此。
