Zheng C C, Zhu X Y, Tang B L, Tong J, Zhang X H, Zhang L, Song K D, Geng L Q, Liu H L, Sun Z M
Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Aug 14;38(8):673-679. doi: 10.3760/cma.j.issn.0253-2727.2017.08.005.
To compare the efficacy of unrelated cord blood transplantation (UCBT) and HLA-identical sibling peripheral blood stem cell transplantation (PBSCT) for the treatment of adult hematological malignancies. From April 2011 to December 2015, a total of 81 patients receiving single-unit UCBT and 57 patients receiving HLA-identical sibling PBSCT were enrolled in this study. All of the patients received myelablative conditioning. Cyclosporine combined with mycophenolate mofetil was adopted for GVHD prophylaxis. The cumulative incidence of neutropil engraftment at day-42 was 95.0% and 100% in UCBT and sibling PBSCT groups, respectively (=0.863) . Platelet engraftment at day 100 was 87.3% (95% 76.8%-93.1%) in UCBT group, which was significantly lower than that of sibling PBSCT group[98.2% (95% 87.3%-99.7%) ] (=0.005) . There were no significant differences in terms of Ⅱ-Ⅳ acute GVHD or Ⅲ-Ⅳ acute GVHD in two groups (=0.142, 0.521) . The 3-year chronic GVHD and extensive chronic GVHD were 14.9% (95% 5.2%-23.5%) and 11.2% (95% 2.9%-18.7%) , respectively in UCBT group, which was significantly lower than that of sibling PBSCT group[35.2% (95% 19.4%-47.8%) , 31.4% (95% 16.2%-43.9%) ] (=0.008, 0.009) . The 3-year transplant-related mortality (TRM) was similar between two groups (30.1% 23.2%, =0.464) . The relapse rate at 3-year in UCBT group[12.9% (95% 6.6%-21.5%) ]was significantly lower than that in sibling PBSCT group[24.3% (95% 13.5%-36.8%) ] (=0.039) . There were no significant differences in terms of overall survival (OS) and disease-free survival (DFS) between two groups (58.6% 54.8%, =0.634; 57.0% 52.4%, =0.563) . But GVHD-free and relapse-free survival (GRFS) in UCBT group [55.7% (95% 44.1%-65.8%) ]was significantly higher than that of sibling PBSCT group[42.9% (95% 29.8%-55.3%) ] (=0.047) . For adult hematological malignancies, the incidences of acute GVHD and TRM were similar between UCBT and sibling PBSCT recipients, and the incidences of chronic GVHD and relapse were lower in UCBT recipients. UCBT recipients had higher GRFS rate although OS and DFS were similar between two groups, which may reflect the real recovery and better quality of life following UCBT.
比较无关脐血移植（UCBT）与人类白细胞抗原（HLA）相合同胞外周血干细胞移植（PBSCT）治疗成人血液系统恶性肿瘤的疗效。2011年4月至2015年12月，本研究共纳入81例接受单单位UCBT的患者和57例接受HLA相合同胞PBSCT的患者。所有患者均接受清髓性预处理。采用环孢素联合霉酚酸酯预防移植物抗宿主病（GVHD）。脐血移植组和同胞外周血干细胞移植组第42天中性粒细胞植入的累积发生率分别为95.0%和100%（P=0.863）。脐血移植组第100天血小板植入率为87.3%（95%可信区间76.8%-93.1%），显著低于同胞外周血干细胞移植组[98.2%（95%可信区间87.3%-99.7%）]（P=0.005）。两组Ⅱ-Ⅳ级急性GVHD或Ⅲ-Ⅳ级急性GVHD发生率无显著差异（P=0.142，0.521）。脐血移植组3年慢性GVHD和广泛性慢性GVHD发生率分别为14.9%（95%可信区间5.2%-23.5%）和11.2%（95%可信区间2.9%-18.7%），显著低于同胞外周血干细胞移植组[35.2%（95%可信区间19.4%-47.8%），31.4%（95%可信区间16.2%-43.9%）]（P=0.008，0.009）。两组3年移植相关死亡率（TRM）相似（30.1%对23.2%，P=0.464）。脐血移植组3年复发率[12.9%（95%可信区间6.6%-21.5%）]显著低于同胞外周血干细胞移植组[24.3%（95%可信区间13.5%-36.8%）]（P=0.039）。两组总生存期（OS）和无病生存期（DFS）无显著差异（58.6%对54.8%，P=0.634；57.0%对52.4%，P=0.563）。但脐血移植组无GVHD和无复发生存期（GRFS）[55.7%（95%可信区间44.1%-65.8%）]显著高于同胞外周血干细胞移植组[42.9%（95%可信区间29.8%-55.3%）]（P=0.047）。对于成人血液系统恶性肿瘤，脐血移植受者和同胞外周血干细胞移植受者急性GVHD和TRM发生率相似，脐血移植受者慢性GVHD和复发发生率较低。脐血移植受者GRFS率较高，尽管两组OS和DFS相似，这可能反映了脐血移植后真正的恢复情况和更好的生活质量。
