成人再生障碍性贫血中脐血移植与无关供者骨髓移植结局的比较
A Comparison of Outcomes for Cord Blood Transplantation and Unrelated Bone Marrow Transplantation in Adult Aplastic Anemia.
作者信息
Kuwatsuka Yachiyo, Kanda Junya, Yamazaki Hirohito, Mori Takehiko, Miyamura Koichi, Kako Shinichi, Uchida Naoyuki, Ohashi Kazuteru, Ozawa Yukiyasu, Takahashi Yoshiyuki, Kato Chiaki, Iwato Koji, Ishiyama Ken, Kobayashi Hikaru, Eto Tetsuya, Kahata Kaoru, Kato Jun, Miyamoto Toshihiro, Kato Koji, Mori Shinicihro, Atsuta Yoshiko, Kimura Fumihiko, Kanda Yoshinobu
机构信息
Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
出版信息
Biol Blood Marrow Transplant. 2016 Oct;22(10):1836-1843. doi: 10.1016/j.bbmt.2016.07.002. Epub 2016 Jul 8.
Earlier reports suggested that umbilical cord blood transplantation (UCBT) for aplastic anemia (AA) was feasible in alternative transplantation. To identify differences in outcomes of UCBT and HLA-matched or mismatched unrelated bone marrow transplantation (UBMT) in adults with AA, we analyzed registry data of the Japan Society for Hematopoietic Cell Transplantation and compared results of UCBT (n = 69) to 8/8-matched (n = 101), 7/8-matched (n = 65), or 6/8-matched (n = 37) UBMT. The transplantation period was from 2002 to 2012, and patients 16 years or older with AA were eligible. Median ages were 49, 35, 28, and 30 years for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively. In multivariate analysis, risk of mortality was lower for 8/8-matched UBMT compared with that of UCBT (hazard ratio [HR], .55; 95% confidence interval [CI], .32 to .94; P = .029), adjusted for age and graft-versus-host disease (GVHD) prophylaxis, which were other associated factors. Mortality risks of 7/8-matched UBMT (HR, .55; 95% CI, .29 to 1.02) or 6/8-matched UBMT (HR, .67; 95% CI, .32 to 1.39) were not significantly different from those of UCBT. Risks of grade 3 or 4 acute and chronic GVHD were not different among the 4 groups. The most prevalent cause of death was graft failure in UCBT and 6/8-matched UBMT and infection in 8/8-matched and 7/8-matched UBMT. Under 40 years old,survival of UCBT was similar to that of UBMT (76%, 79%, 83%, and 83% for UCBT and 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years), adjusted for transplantation period, which was another associated factor; however, for ages over 40 years, that of UCBT tended to be lower (47%, 64%, 64%, and 75% for UCBT, 8/8-matched, 7/8-matched, and 6/8-matched UBMT, respectively, at 3 years). To conclude, these data suggest that UCBT could be an alternative treatment option for younger adults when matched sibling or adequate UBMT donors are not available.
早期报告表明，脐血移植（UCBT）治疗再生障碍性贫血（AA）在替代移植中是可行的。为了确定成人AA患者中UCBT与人类白细胞抗原（HLA）匹配或不匹配的无关骨髓移植（UBMT）的结果差异，我们分析了日本造血细胞移植学会的登记数据，并将UCBT（n = 69）的结果与8/8匹配（n = 101）、7/8匹配（n = 65）或6/8匹配（n = 37）的UBMT结果进行了比较。移植期为2002年至2012年，16岁及以上的AA患者符合条件。UCBT、8/8匹配、7/8匹配和6/8匹配的UBMT的中位年龄分别为49岁、35岁、28岁和30岁。在多变量分析中，与UCBT相比，8/8匹配的UBMT的死亡风险较低（风险比[HR]，0.55；95%置信区间[CI]，0.32至0.94；P = 0.029），对年龄和移植物抗宿主病（GVHD）预防进行了调整，这是其他相关因素。7/8匹配的UBMT（HR，0.55；95%CI，0.29至1.02）或6/8匹配的UBMT（HR，0.67；95%CI，0.32至1.39）的死亡风险与UCBT没有显著差异。4组中3级或4级急性和慢性GVHD的风险没有差异。最常见的死亡原因在UCBT和6/8匹配的UBMT中是移植失败，在8/8匹配和7/8匹配的UBMT中是感染。在40岁以下，UCBT的生存率与UBMT相似（UCBT以及8/8匹配、7/8匹配和6/8匹配的UBMT在3年时分别为76%、79%、83%和83%），对移植期进行了调整，这是另一个相关因素；然而，对于40岁以上的患者，UCBT的生存率往往较低（UCBT、8/8匹配、7/8匹配和6/8匹配的UBMT在3年时分别为47%、64%、64%和75%）。总之，这些数据表明，当没有匹配的同胞或合适的UBMT供体时，UCBT可能是年轻成年人的一种替代治疗选择。
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