Korula Anu, Devasia Anup J, Fouzia N A, Nisham P N, Kulkarni Uday, Lakshmi Kavitha M, Abraham Aby, Srivastava Alok, Mathews Vikram, George Biju
Department of Haematology, Christian Medical College and Hospital, Vellore, 632004 India.
Indian J Hematol Blood Transfus. 2019 Jan;35(1):43-49. doi: 10.1007/s12288-018-0988-z. Epub 2018 Aug 13.
For patients requiring allogeneic stem cell transplant, in the absence of a HLA-matched sibling, an extended donor search within the family may yield a suitable donor especially in societies with a high prevalence of consanguinity. We describe outcomes in transplants with non-sibling family donors, and compare outcomes with controls having a sibling donor transplant. Retrospective analysis of all matched related (non-sibling) donor transplants between 1995 and 2015. For comparison, appropriate age, sex and disease-matched patients were chosen from the sibling transplants (MSD) performed during the same time period (± 2 years). Comparison between the fully matched non-sibling donor cohort and age, sex and disease-matched sibling donor transplants showed a significant increase in complications in the family donor group (viral infections, acute GVHD and rejection). Event-free survival and overall survival were significantly lower in the non-sibling donor cohort, and HLA disparity (1-2 antigen) further worsened the adverse impact. Though there was a significantly lower event-free and overall survival at 3 years in the family donor cohort, this did not retain significance in the multivariate analysis. This data on allogeneic transplants using family donors showed higher complication rates and poorer outcomes. However in situations where financial constraints prevent access to matched unrelated donor sources, extended family searches may be fruitful in yielding a donor, and modifications in conditioning regimens and improvement in supportive care may help in improving the outcomes in family donor transplants.
对于需要进行异基因干细胞移植的患者，如果没有 HLA 匹配的同胞供者，在家族内部扩大供者搜索范围可能会找到合适的供者，尤其是在近亲结婚率较高的社会中。我们描述了非同胞家族供者移植的结果，并与同胞供者移植的对照组结果进行比较。对 1995 年至 2015 年间所有匹配的相关（非同胞）供者移植进行回顾性分析。为作比较，从同一时期（±2 年）进行的同胞移植（MSD）中选取年龄、性别和疾病匹配的患者。完全匹配的非同胞供者队列与年龄、性别和疾病匹配的同胞供者移植之间的比较显示，家族供者组的并发症显著增加（病毒感染、急性移植物抗宿主病和排斥反应）。非同胞供者队列的无事件生存率和总生存率显著较低，HLA 差异（1-2 个抗原）进一步加重了不良影响。虽然家族供者队列在 3 年时的无事件生存率和总生存率显著较低，但在多变量分析中这一差异不再显著。这些关于使用家族供者进行异基因移植的数据显示并发症发生率较高且结果较差。然而，在经济限制使得无法获得匹配的无关供者来源的情况下，在家族内部扩大搜索范围可能会成功找到供者，调整预处理方案和改善支持治疗可能有助于改善家族供者移植的结果。
