Department of Hematology and Oncology, Konan Kosei Hospital, Konan, Japan.
Department of Hematology and Oncology, Konan Kosei Hospital, Konan, Japan.
Biol Blood Marrow Transplant. 2018 Jul;24(7):1455-1462. doi: 10.1016/j.bbmt.2018.02.013. Epub 2018 Feb 21.
The hematopoietic cell transplantation-specific comorbidity index (HCT-CI) has been recently proposed to predict the probability of nonrelapse mortality (NRM) and overall survival (OS) in allogeneic hematopoietic stem cell transplantation (HSCT). However, the usefulness of the HCT-CI in single-unit umbilical cord blood transplantation (UCBT) remains unclear. We investigated the impact of the HCT-CI on the clinical outcomes of allogeneic HSCT in a single-center retrospective study including 53 recipients of UCBT (UCBT group) and 90 recipients of other HSCT (non-UCBT group). In the non-UCBT group 2-year OS rates for HCT-CI score < 3 and ≥3 were 67% (n = 74; 95% confidence interval [CI], 54% to 78%) and 26% (n = 16; 95% CI, 7% to 51%), respectively (P = .001). In the UCBT group these rates were 66% (n = 39; 95% CI, 48% to 79%) and 69% (n = 14; 95% CI, 36% to 87%), respectively (P = .73). In the non-UCBT group 1-year NRM rates for HCT-CI score < 3 and ≥3 were 14% (95% CI, 6.4% to 22%) and 37% (95% CI, 14% to 61%), respectively (P = .02). In the UCBT group these rates were 6.1% (95% CI, 3.4% to 24%) and 7.7% (95% CI, .4% to 29%), respectively (P = .78). Using multivariate analysis we showed that HCT-CI score ≥ 3 was significantly associated with lower OS (hazard ratio, 3.06; 95% CI, 1.47 to 6.38; P = .003) and higher NRM (hazard ratio, 2.87; 95% CI, 1.18 to 6.96; P = .02) for the non-UCBT group. UCBT showed good OS with low incidence of NRM, even in patients with high HCT-CI scores. Altogether, we propose single-unit UCB to be a promising stem cell source for improving survival in patients with multiple comorbidities.
造血细胞移植特异性合并症指数（HCT-CI）最近被提出用于预测异基因造血干细胞移植（HSCT）中的非复发死亡率（NRM）和总生存率（OS）的概率。然而，HCT-CI 在单份脐带血移植（UCBT）中的作用尚不清楚。我们在一项单中心回顾性研究中调查了 HCT-CI 对所有接受 UCBT（UCBT 组）和 90 名接受其他 HSCT（非 UCBT 组）的患者的临床结局的影响。在非 UCBT 组中，HCT-CI 评分<3 和≥3 的 2 年 OS 率分别为 67%（n=74；95%置信区间[CI]，54%至 78%）和 26%（n=16；95%CI，7%至 51%）（P=0.001）。在 UCBT 组中，这些比率分别为 66%（n=39；95%CI，48%至 79%）和 69%（n=14；95%CI，36%至 87%）（P=0.73）。在非 UCBT 组中，HCT-CI 评分<3 和≥3 的 1 年 NRM 率分别为 14%（95%CI，6.4%至 22%）和 37%（95%CI，14%至 61%）（P=0.02）。在 UCBT 组中，这些比率分别为 6.1%（95%CI，3.4%至 24%）和 7.7%（95%CI，0.4%至 29%）（P=0.78）。通过多变量分析，我们表明 HCT-CI 评分≥3 与非 UCBT 组较低的 OS（风险比，3.06；95%CI，1.47 至 6.38；P=0.003）和较高的 NRM（风险比，2.87；95%CI，1.18 至 6.96；P=0.02）显著相关。UCBT 表现出良好的 OS，NRM 发生率低，即使在 HCT-CI 评分较高的患者中也是如此。总之，我们提出单份 UCB 是改善合并症较多患者生存的有前途的干细胞来源。
