Harada Kaito, Fuji Shigeo, Seo Sachiko, Kanda Junya, Ueki Toshimitsu, Kimura Fumihiko, Kato Koji, Uchida Naoyuki, Ikegame Kazuhiro, Onizuka Makoto, Matsuoka Ken-Ichi, Doki Noriko, Kawakita Toshiro, Onishi Yasushi, Yano Shingo, Fukuda Takahiro, Takanashi Minoko, Kanda Yoshinobu, Atsuta Yoshiko, Ogata Masao
Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan.
Department of Hematology, Osaka International Cancer Institute, Osaka, Japan.
Bone Marrow Transplant. 2020 Sep;55(9):1784-1795. doi: 10.1038/s41409-020-0821-9. Epub 2020 Feb 12.
Graft failure (GF) is a life-threatening complication after allogeneic stem cell transplantation (SCT). Although salvage SCTs can be performed with haploidentical donor (HID) or cord blood (CB), no study has compared the performances of these two sources. Using nationwide registration data, we compared the transplant outcomes of patients who developed GF and underwent salvage transplantation from HID (n = 129) and CB (n = 570) from 2007 to 2016. The HID group demonstrated better neutrophil recovery (79.7 vs. 52.5% at 30 days, P < 0.001). With a median follow-up of 3 years, both groups demonstrated similar overall survival (OS) and nonrelapse mortality (NRM; 1-year OS, 33.1 vs. 34.6% and 1-year NRM, 45.1 vs. 49.8% for the HID and CB groups). After adjustments for other covariates, OS did not differ in both groups. However, HID was associated with a lower NRM (hazard ratio, 0.71; P = 0.038) than CB. The incidence of acute graft-versus-host disease (GVHD)-related deaths was significantly higher in the HID group, although infection-related deaths were observed more frequently in the CB group. HID may be a promising salvage SCT option after GF due to its faster engraftment and low NRM.
移植物失败（GF）是异基因干细胞移植（SCT）后一种危及生命的并发症。尽管挽救性SCT可以使用单倍体相合供者（HID）或脐血（CB）进行，但尚无研究比较这两种来源的表现。利用全国登记数据，我们比较了2007年至2016年发生GF并接受来自HID（n = 129）和CB（n = 570）的挽救性移植患者的移植结局。HID组显示出更好的中性粒细胞恢复情况（30天时为79.7%对52.5%，P < 0.001）。中位随访3年时，两组的总生存期（OS）和非复发死亡率（NRM）相似（HID组和CB组的1年OS分别为33.1%对34.6%，1年NRM分别为45.1%对49.8%）。在对其他协变量进行调整后，两组的OS无差异。然而，HID与低于CB的NRM相关（风险比，0.71；P = 0.038）。尽管CB组感染相关死亡更常见，但HID组急性移植物抗宿主病（GVHD）相关死亡的发生率显著更高。由于其更快的植入和低NRM，HID可能是GF后一种有前景的挽救性SCT选择。
