Yao J F, Zhang G X, Shen Y Y, Zhang R L, He Y, Wei J L, Jiang E L, Yang D L, Feng S Z, Han M Z
Institute of Hematology and Blood Diseases Hospital, CAMS & PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2019 Jun 14;40(6):460-466. doi: 10.3760/cma.j.issn.0253-2727.2019.06.003.
To evaluate the outcomes of human leukocyte antigen (HLA) matched unrelated donor hematopoietic stem cell transplantation (MUD-HSCT) for adult acute myeloid leukemia (AML) in a single center. Consecutive adult AML who received MUD-HSCT in our center from January 2008 to April 2017 were studied retrospectively, comparing with patients undergoing matched sibling donor (MSD) -HSCT in the same period. The rates of overall survival (OS) , disease free survival (DFS) , relapse, non-relapse mortality (NRM) , engraftment, acute and chronic graft-versus-host disease (aGVHD and cGVHD) were analyzed. A total of 247 consecutive cases were enrolled, including 46 patients with MUD-HSCT and 201 with MSD-HSCT. All the patients experienced neutrophil engraftment except for one patient who died early in the MSD group, but the median day of engraftment was longer in the MUD group (15.0 14.0, =0.017) . The accumulative engraftment rate of platelet was comparable between the two groups (93.5% 98.0%, =0.128) . The accumulative incidences of aGVHD (50.0% 46.3%, =0.421) and cGVHD (37.8% 43.0%, =0.581) were not statistically different between the two groups. Compared with the MSD group, the accumulative NRM rate at+36 months after transplantation was significantly higher in the MUD group (22.0% 10.4%, =0.049) , while the relapse rate was not statistical difference (20.5 28.3%, =0.189) . Both the 3-year OS (61.6% 63.3%, =0.867) and DFS (57.5% 61.6%, =0.760) were comparable between the two groups. Four independent risk factors were confirmed by the multivariate analysis: patient age ≥45 years old, CR2 or NR before transplantation, a history of extramedullary infiltration and the occurrence of grade Ⅲ-Ⅳ aGVHD. No statistical differences were demonstrated in the survival rate between MUD-and MSD-HSCT in different subgroups. The outcomes, such as GVHD, relapse, OS and DFS, were comparable between MUD-and MSD-HSCT for adult AML, but higher incidence of NRM and longer time to neutrophil engraftment in the MUD group. MUD-HSCT is practical and feasible for adult AML who are lack of MSD.
评估单中心人类白细胞抗原（HLA）配型相合的非血缘供者造血干细胞移植（MUD-HSCT）治疗成人急性髓系白血病（AML）的疗效。回顾性研究2008年1月至2017年4月在本中心接受MUD-HSCT的连续性成人AML患者，并与同期接受同胞全相合供者（MSD）-HSCT的患者进行比较。分析总生存（OS）率、无病生存（DFS）率、复发率、非复发死亡率（NRM）、植入率、急性和慢性移植物抗宿主病（aGVHD和cGVHD）发生率。共纳入247例连续性病例，其中MUD-HSCT患者46例，MSD-HSCT患者201例。除MSD组1例早期死亡患者外，所有患者均实现中性粒细胞植入，但MUD组中性粒细胞植入中位天数更长（15.0对14.0，P=0.017）。两组血小板累积植入率相当（93.5%对98.0%，P=0.128）。两组aGVHD累积发生率（50.0%对46.3%，P=0.421）和cGVHD累积发生率（37.8%对43.0%，P=0.581）差异无统计学意义。与MSD组相比，MUD组移植后36个月时累积NRM率显著更高（22.0%对10.4%，P=0.049），而复发率差异无统计学意义（20.5%对28.3%，P=0.189）。两组3年OS率（61.6%对63.3%，P=0.867）和DFS率（57.5%对61.6%，P=0.760）相当。多因素分析确定了4个独立危险因素：患者年龄≥45岁、移植前CR2或未缓解、髓外浸润史和Ⅲ-Ⅳ级aGVHD的发生。不同亚组中MUD-HSCT与MSD-HSCT的生存率差异无统计学意义。对于成人AML，MUD-HSCT与MSD-HSCT在GVHD、复发、OS和DFS等方面疗效相当，但MUD组NRM发生率更高，中性粒细胞植入时间更长。MUD-HSCT对于缺乏MSD的成人AML患者是切实可行的。
