Zhang Yuan-Yuan, Mo Wen-Jian, Zuo Yang-Yang, Zhou Ming, Zhang Xiao-Hui, Wang Yu, Li Yu-Miao, Zhang Yu-Ping, Chen Yu-Hong, Chen Xiao-Wei, Mo Xiao-Dong, Wang Cai-Xia, Lin Fan, Huang Xiao-Jun, Wang Shun-Qing, Xu Lan-Ping
Peking University Institute of Haematology, National Clinical Research Centre for Hematologic Disease, Beijing Key Laboratory of Haematopoietic Stem Cell Transplantation, Peking University People's Hospital, Beijing, China.
Department of Hematology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Clin Transplant. 2020 Mar;34(3):e13810. doi: 10.1111/ctr.13810. Epub 2020 Feb 20.
This retrospective multicenter cohort study aimed to compare the outcome of haploidentical hematopoietic stem cell transplantation (HID-HSCT) with matched sibling donor (MSD) and unrelated donor (URD) transplantation in severe aplastic anemia (SAA) patients 40 years of age and older. With a median follow-up time of 17.6 months, 85 consecutive patients were enrolled in the study, and the median patient age was 45 years (40, 58). The cumulative engraftment rates of neutrophil and platelet were 98.8 ± 0.0% and 92.9 ± 0.1%. The cumulative incidences of Grade 2-4 acute graft-versus-host disease (aGvHD) and chronic graft-versus-host disease (cGvHD) at 3 years were 14.1 ± 0.1% and 17.3 ± 0.2%. The 3-year estimated overall survival (OS) and failure-free survival (FFS) were 91.2 ± 3.2% and 89.7 ± 3.5%. In multivariate analysis, the only factor associated with inferior survival was an ECOG score ≥2. HID-HSCT was associated with a higher incidence of GvHD, but the difference of 3-year estimated OS between HID group and the other two cohorts was not significant (86.7 ± 6.4% for HID vs 92.1% ± 4.4% for MSD and 100% for URD, P = .481). HID-HSCT might be a feasible alternative option for selected SAA patients aged 40 years and older without a matched donor.
这项回顾性多中心队列研究旨在比较单倍体相合造血干细胞移植（HID-HSCT）与同胞全相合供者（MSD）及无关供者（URD）移植治疗40岁及以上重型再生障碍性贫血（SAA）患者的疗效。中位随访时间为17.6个月，85例连续患者纳入本研究，患者中位年龄为45岁（40，58）。中性粒细胞和血小板的累积植入率分别为98.8±0.0%和92.9±0.1%。3年时2-4级急性移植物抗宿主病（aGvHD）和慢性移植物抗宿主病（cGvHD）的累积发生率分别为14.1±0.1%和17.3±0.2%。3年估计总生存率（OS）和无失败生存率（FFS）分别为91.2±3.2%和89.7±3.5%。多因素分析中，与生存较差相关的唯一因素是东部肿瘤协作组（ECOG）评分≥2。HID-HSCT与移植物抗宿主病（GvHD）发生率较高相关，但HID组与其他两组3年估计总生存率的差异无统计学意义（HID组为86.7±6.4%，MSD组为92.1%±4.4%，URD组为100%，P=0.481）。对于40岁及以上无全相合供者的特定SAA患者，HID-HSCT可能是一种可行的替代选择。
