Picardi Alessandra, Arcese William, Pollichieni Simona, Di Piazza Fabio, Mangione Ilaria, Gallina Anna Maria, Cerretti Raffaella, Cudillo Laura, De Angelis Gottardo, Mengarelli Andrea, Dentamaro Teresa, Tirindelli Maria Cristina, Chierichini Anna, Ferrari Antonella, Marciano Renato, Andreani Marco, Bonifazi Francesca, Sacchi Nicoletta
Department of Biomendicina e Prevenzione of Tor Vergata University, Hematology Stem Cell Transplant Unit, Rome, Italy.
Italian Bone MarrowDonorRegistry, Ospedale Galliera, Genoa, Italy.
Transfusion. 2017 Jul;57(7):1734-1743. doi: 10.1111/trf.14131. Epub 2017 Jun 13.
From 2011 to 2014, a total of 71% of the 3834 patients with hematologic malignancies successfully identified a matched unrelated donor (MUD) through the Italian Bone Marrow Donor Registry (IBMDR), corresponding to a transplant efficiency of 62%.
From 2006, the Rome Transplant Network (RTN) followed a hierarchical selection strategy for the alternative donor search: first MUD, second cord blood, and third haploidentical donor. Using a low-resolution HLA, a preliminary query (PQ) was performed in all cases with assignment of good or poor score if more or less than 10 MUDs were identified in Bone Marrow Donors Worldwide. Herein we assessed the utility of PQ and of high-resolution (HR) HLA from the start of the search. Moreover, we compared the donor identification and the transplant efficiency between IBMDR and RTN.
At RTN 79% of 417 patients met a good PQ with a 50% MUD identification versus 12.5% with poor PQ. Our policy led to 78 and 74% of alternative donor identification and transplant efficiency, respectively, higher than IBMDR data equal to 71% (p = 0.007) and 62% (p < 0.0001). The timing for donor identification was significantly reduced using HR HLA at the start of the search from 88 to 66 days at IBMDR (p < 0.001) and from 61 to 41 days at RTN (p < 0.001).
Both PQ and HR HLA at the start of the process represents a useful tool to address the search towards the best and timely donor choice. Moreover, establishing a specific donor policy significantly improves the transplant efficiency.
2011年至2014年，在3834例血液系统恶性肿瘤患者中，共有71%的患者通过意大利骨髓捐献者登记处（IBMDR）成功找到了匹配的无关供者（MUD），移植效率为62%。
自2006年起，罗马移植网络（RTN）采用分层选择策略进行替代供者搜索：首选MUD，其次是脐血，第三是单倍体相合供者。使用低分辨率HLA，对所有病例进行初步查询（PQ），如果在全球骨髓捐献者中识别出的MUD数量多于或少于10个，则分别给予高分或低分。在此，我们从搜索开始就评估了PQ和高分辨率（HR）HLA的效用。此外，我们比较了IBMDR和RTN之间的供者识别情况和移植效率。
在RTN，417例患者中有79%的患者PQ结果良好，MUD识别率为50%，而PQ结果不佳的患者MUD识别率为12.5%。我们的策略分别使替代供者识别率和移植效率达到78%和74%，高于IBMDR的数据，分别为71%（p = 0.007）和62%（p < 0.0001）。在搜索开始时使用HR HLA，供者识别时间显著缩短，在IBMDR从88天缩短至66天（p < 0.001），在RTN从61天缩短至41天（p < 0.001）。
在搜索过程开始时使用PQ和HR HLA都是有助于寻找最佳和及时供者选择的有用工具。此外，制定特定的供者策略可显著提高移植效率。
