Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.
Eurocord, Hôpital Saint Louis, Université Paris-Diderot, Paris, France; Service d'Hématologie et Thérapie Cellulaire, Hôpital Saint Antoine, Paris, France; INSERM, URM_S 938, Université Pierre et Marie Curie, Paris, France.
Biol Blood Marrow Transplant. 2018 Aug;24(8):1657-1663. doi: 10.1016/j.bbmt.2018.02.014. Epub 2018 Mar 1.
Usually, after double umbilical cord blood transplantation (DUCBT), only 1 of the transplanted units persists in the long term. The characteristics of the winning cord blood unit (W-CBU) that determine unit dominance and how they influence the outcomes of DUCBT remain unclear. We retrospectively analyzed 347 patients with acute leukemia transplanted with a DUCBT (694 CBU) from 2005 to 2013 who had documented neutrophil engraftment and a W-CBU identified by chimerism analysis, to identify unit characteristics impacting on dominance. Median age at DUCBT was 40 years and median follow-up was 35 months. Among W-CBUs, 41% were ≥5/6 HLA matched to the recipient and 59% were ≤4/6. Multivariate analysis indicated that ≤4/6 HLA-matched W-CBUs led to lower leukemia-free survival (44% versus 56%; hazard ratio [HR], 1.5; P = .032) and overall survival (49% versus 62%; HR, 1.5; P = .028), increased nonrelapse mortality (26% versus 18%; HR, 1.9; P = .027), and acute graft-versus-host disease (46% versus 35%; HR, 1.7; P = .013). We were unable to predict unit dominance, but we demonstrated that outcomes were strongly influenced by the degree of HLA mismatch between W-CBU and recipient. Therefore, selection of both units with the lower number of HLA mismatches with the recipient is indicated.
通常情况下，在双脐带血移植（DUCBT）后，只有 1 个移植单位能够长期存在。决定单位优势的获胜脐带血单位（W-CBU）的特征以及它们如何影响 DUCBT 的结果尚不清楚。我们回顾性分析了 2005 年至 2013 年间接受 DUCBT（694 个 CBU）移植的 347 例急性白血病患者的资料，这些患者均有中性粒细胞植入和嵌合分析确定的 W-CBU，以确定影响优势的单位特征。DUCBT 时的中位年龄为 40 岁，中位随访时间为 35 个月。在 W-CBU 中，41%与受者至少有 5/6 HLA 匹配，59%的匹配程度≤4/6。多变量分析表明，≤4/6 HLA 匹配的 W-CBU 导致无白血病生存率（44%比 56%；危险比 [HR]，1.5；P=0.032）和总生存率（49%比 62%；HR，1.5；P=0.028）降低，非复发死亡率增加（26%比 18%；HR，1.9；P=0.027），急性移植物抗宿主病（46%比 35%；HR，1.7；P=0.013）。我们无法预测单位优势，但我们证明，结果受 W-CBU 与受者之间 HLA 错配程度的强烈影响。因此，建议选择与受者 HLA 错配数量较少的两个单位。
