Kanda Junya, Hayashi Hiromi, Ruggeri Annalisa, Kimura Fumihiko, Volt Fernanda, Takahashi Satoshi, Kako Shinichi, Tozatto-Maio Karina, Yanada Masamitsu, Sanz Guillermo, Uchida Naoyuki, Angelucci Emanuele, Kato Seiko, Mohty Mohamad, Forcade Edouard, Tanaka Masatsugu, Sierra Jorge, Ohta Takanori, Saccardi Riccardo, Fukuda Takahiro, Ichinohe Tatsuo, Kimura Takafumi, Rocha Vanderson, Okamoto Shinichiro, Nagler Arnon, Atsuta Yoshiko, Gluckman Eliane
Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Eurocord, Hospital Saint Louis, AP-HP, IUH University Paris VII, Paris, France.
Bone Marrow Transplant. 2022 Jan;57(1):57-64. doi: 10.1038/s41409-021-01479-4. Epub 2021 Oct 11.
The impact of GVHD and graft-versus-leukemia effect in unrelated cord blood transplantation (UCBT) is controversial. In the Eurocord/ALWP EBMT and JSTCT/JDCHCT collaborative study, we evaluated the impact of GVHD on UCBT outcomes in Japanese and European registries. A total of 3,690 adult patients with acute leukemia who received their first single UCBT were included. A multivariate analysis of overall survival (OS) revealed a positive impact of grade II acute GVHD compared with grade 0-I GVHD, in the Japanese cohort (hazard ratio (HR), 0.81; P = 0.001), and an adverse impact in the European cohort (HR, 1.37; P = 0.007). A negative impact of grade III-IV acute GVHD on OS was observed regardless of registries. In the analysis of relapse, a positive impact of grade II acutes GVHD compared with grade 0-I GVHD was observed only in the Japanese cohort, regardless of disease risk. The positive impact of limited chronic GVHD on OS was observed only in the Japanese cohort. In conclusion, a positive impact of mild GVHD after a single UCBT was observed only in the Japanese cohort. This could explain the ethnic difference in UCBT outcomes and might contribute to the preference usage of UCBT in Japan.
移植物抗宿主病（GVHD）和移植物抗白血病效应在非亲缘脐血移植（UCBT）中的影响存在争议。在欧洲脐血库/欧洲血液与骨髓移植协会（EBMT）以及日本脐带血移植学会/日本儿童造血细胞移植协作组（JSTCT/JDCHCT）的联合研究中，我们评估了GVHD对日本和欧洲登记处UCBT结果的影响。总共纳入了3690例接受首次单次UCBT的成年急性白血病患者。对总生存期（OS）的多因素分析显示，在日本队列中，与0-I级GVHD相比，II级急性GVHD具有积极影响（风险比（HR），0.81；P = 0.001），而在欧洲队列中具有不利影响（HR，1.37；P = 0.007）。无论登记处如何，均观察到III-IV级急性GVHD对OS有负面影响。在复发分析中，仅在日本队列中观察到与0-I级GVHD相比，II级急性GVHD具有积极影响，且与疾病风险无关。仅在日本队列中观察到局限性慢性GVHD对OS有积极影响。总之，仅在日本队列中观察到单次UCBT后轻度GVHD具有积极影响。这可以解释UCBT结果中的种族差异，并且可能有助于UCBT在日本的优先使用。
