Konuma Takaaki, Kato Seiko, Oiwa-Monna Maki, Tanoue Susumu, Ogawa Miho, Isobe Masamichi, Tojo Arinobu, Takahashi Satoshi
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Biol Blood Marrow Transplant. 2017 Jul;23(7):1142-1150. doi: 10.1016/j.bbmt.2017.03.036. Epub 2017 Apr 5.
Low cryopreserved total nucleated cell (TNC) dose in a cord blood (CB) unit has been shown to be associated with engraftment failure and mortality after single-unit cord blood transplantation (CBT) in adults. Although CB banks offer specific characteristics of cryopreserved cell dose, such as TNC, CD34 cells, and colony-forming unit for granulocyte/macrophage (CFU-GM), the impact of each cell dose on engraftment and outcomes after single-unit CBT in adults remains unclear. We retrospectively analyzed the results of 306 CBTs for 261 adult patients in our institution between 1998 and 2016. The median age was 43 years (range, 16 to 68), the median actual body weight (ABW) was 56.2 kg (range, 36.2 to 104.0), the median ideal body weight (IBW) was 62.3 kg (range, 39.7 to 81.3), the median TNC dose was 2.46 × 10/ABW kg (range, 1.07 to 5.69), the median CD34 cell dose was .91 × 10/ABW kg (range, .15 to 7.75), and the median CFU-GM dose was 24.46 × 10/ABW kg (range, .04 to 121.81). Among patients who achieved engraftment, the speed of neutrophil, platelet, and red blood cell engraftment significantly correlated with CD34 cell dose, but not with TNC and CFU-GM dose, based on both ABW and IBW. In multivariate analysis, the incidence of extensive chronic graft-versus-host disease (GVHD) was significantly higher in patients receiving the highest CD34 cell dose, based on both ABW and IBW. Nevertheless, no cell dose was associated with survival, transplantation-related mortality, and relapse. In conclusion, cryopreserved CD34 cell dose was the best predictor for hematopoietic recovery and extensive chronic GVHD after CBT. The cryopreserved CD34 cell dose should be used for unit selection criteria in single-unit CBT for adults.
在成人单单位脐血移植（CBT）中，脐血（CB）单位中低温保存的全有核细胞（TNC）剂量低已被证明与植入失败和死亡率相关。尽管脐血库提供了低温保存细胞剂量的特定特征，如TNC、CD34细胞和粒细胞/巨噬细胞集落形成单位（CFU-GM），但每种细胞剂量对成人单单位CBT后植入和结局的影响仍不清楚。我们回顾性分析了1998年至2016年间我院261例成年患者的306例CBT结果。中位年龄为43岁（范围16至68岁），中位实际体重（ABW）为56.2 kg（范围36.2至104.0），中位理想体重（IBW）为62.3 kg（范围39.7至81.3），中位TNC剂量为2.46×10⁸/ABW kg（范围1.07至5.69），中位CD34细胞剂量为0.91×10⁶/ABW kg（范围0.15至7.75），中位CFU-GM剂量为24.46×10⁴/ABW kg（范围0.04至121.81）。在实现植入的患者中，基于ABW和IBW，中性粒细胞、血小板和红细胞的植入速度与CD34细胞剂量显著相关，但与TNC和CFU-GM剂量无关。在多变量分析中，基于ABW和IBW，接受最高CD34细胞剂量的患者广泛慢性移植物抗宿主病（GVHD）的发生率显著更高。然而，没有细胞剂量与生存率、移植相关死亡率和复发相关。总之，低温保存的CD34细胞剂量是CBT后造血恢复和广泛慢性GVHD的最佳预测指标。低温保存的CD34细胞剂量应用于成人单单位CBT的单位选择标准。
