Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei, China.
Biol Blood Marrow Transplant. 2017 Dec;23(12):2118-2126. doi: 10.1016/j.bbmt.2017.08.011. Epub 2017 Aug 12.
The European Group for Blood and Marrow Transplantation (EBMT) risk score has been implemented as an important tool to predict patient outcomes after allogeneic hematopoietic stem cell transplantation. However, to our knowledge, this score has never been applied in cases of single umbilical cord blood transplantation (sUCBT). We retrospectively analyzed 207 consecutive patients with acute leukemia who received sUCBT at our center between February 2011 and December 2015. The probabilities of 3-year overall survival (OS) and leukemia-free survival (LFS) of the entire cohort were 65.0% and 59.8%, respectively, whereas the cumulative incidences of 3-year nonrelapse mortality (NRM) and relapse rate were 19.5% and 20.3%, respectively. In the univariate analysis, a higher EBMT risk score was associated with worse OS and LFS and higher NRM and relapse rate, ranging from 81.7%, 75.9%, 7.3%, and 15.3%, respectively, for patients with a score of 1 to 43.8%, 44.3%, 31.7%, and 23.9%, respectively, for patients with scores of 4 to 6. Hazard ratios of OS, LFS, and NRM all steadily increased for each additional score point. Importantly, the prognostic value of the EBMT risk score on OS, LFS, NRM, and relapse was maintained in the multivariate analysis. Moreover, considering the univariate analysis results of donor-recipient gender and mismatched allele-level HLA-A, -B, -C, and -DRB1 loci on patient outcomes and the fairly strong interaction between time from diagnosis to sUCBT and disease status, we developed a modified sUCBT-EBMT risk score by using degrees of 8-allele HLA match instead of donor type, donor-recipient gender combination, and time from diagnosis to sUCBT, and found that the modified score could also be used as a predictor for patient outcomes after sUCBT. The EBMT risk score is a good predictor of outcomes of patients with leukemia after sUCBT. The modified sUCBT-EBMT risk score can also be used as a pretransplant risk assessment, but this metric still requires further evaluation with a larger cohort.
欧洲血液和骨髓移植学会（EBMT）风险评分已被用作预测异基因造血干细胞移植后患者结局的重要工具。然而，据我们所知，该评分从未应用于单脐血造血干细胞移植（sUCBT）病例。我们回顾性分析了 207 例 2011 年 2 月至 2015 年 12 月在本中心接受 sUCBT 的急性白血病患者。整个队列的 3 年总生存率（OS）和无白血病生存率（LFS）分别为 65.0%和 59.8%，而 3 年非复发死亡率（NRM）和复发率的累积发生率分别为 19.5%和 20.3%。单因素分析显示，较高的 EBMT 风险评分与较差的 OS、LFS 和更高的 NRM 和复发率相关，评分 1 至 4 的患者分别为 81.7%、75.9%、7.3%和 15.3%，评分 4 至 6 的患者分别为 44.3%、44.3%、31.7%和 23.9%。OS、LFS 和 NRM 的风险比均随评分增加而稳步升高。重要的是，EBMT 风险评分对 OS、LFS、NRM 和复发的预后价值在多因素分析中得以维持。此外，考虑到供受者性别和错配等位基因 HLA-A、-B、-C 和-DRB1 位点对患者结局的单因素分析结果以及从诊断到 sUCBT 和疾病状态的时间之间相当强的相互作用，我们使用 8 个等位基因 HLA 匹配程度而不是供者类型、供受者性别组合和从诊断到 sUCBT 的时间，开发了改良的 sUCBT-EBMT 风险评分，并发现改良评分也可用于预测 sUCBT 后患者结局。EBMT 风险评分是 sUCBT 后白血病患者结局的良好预测指标。改良的 sUCBT-EBMT 风险评分也可作为移植前风险评估，但仍需要用更大的队列进一步评估。
