Shimomura Yoshimitsu, Sobue Tomotaka, Hirabayashi Shigeki, Kondo Tadakazu, Mizuno Shohei, Kanda Junya, Fujino Takahiro, Kataoka Keisuke, Uchida Naoyuki, Eto Tetsuya, Miyakoshi Shigesaburo, Tanaka Masatsugu, Kawakita Toshiro, Yokoyama Hisayuki, Doki Noriko, Harada Kaito, Wake Atsushi, Ota Shuichi, Takada Satoru, Takahashi Satoshi, Kimura Takafumi, Onizuka Makoto, Fukuda Takahiro, Atsuta Yoshiko, Yanada Masamitsu
Department of Hematology, Kobe City Hospital Organization Kobe City Medical Center General Hospital, Kobe, Japan.
Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, Suita, Japan.
Leukemia. 2022 Apr;36(4):1132-1138. doi: 10.1038/s41375-021-01474-0. Epub 2021 Nov 24.
Cord blood transplantation (CBT) is an alternative donor transplantation method and has the advantages of rapid availability and the possibility of inducing a more potent graft-versus-leukemia effect, leading to a lower relapse rate for patients with non-remission relapse and refractory acute myeloid leukemia (R/R AML). This study aimed to investigate the impact of CBT, compared to human leukocyte antigen-matched related donor transplantation (MRDT). This study included 2451 adult patients with non-remission R/R AML who received CBT (1738 patients) or MRDT (713 patients) between January 2009 and December 2018. Five-year progression-free survival (PFS) and the prognostic impact of CBT were evaluated using a propensity score (PS) matching analysis. After PS matching, the patient characteristics were well balanced between the groups. The five-year PFS was 25.2% (95% confidence interval [CI]: 21.2-29.5%) in the CBT group and 18.1% (95% CI: 14.5-22.0%) in the MRDT group (P = 0.009). The adjusted hazard ratio (HR) was 0.83 (95% CI: 0.69-1.00, P = 0.045); this was due to a more pronounced decrease in the relapse rate (HR: 0.78, 95% CI: 0.69-0.89, P < 0.001) than an increase in the NRM (1.42, 1.15-1.76, P = 0.001). In this population, CBT was associated with a better 5-year PFS than MRDT after allogeneic HSCT.
脐血移植（CBT）是一种替代供体移植方法，具有快速可用的优点，并且有可能诱导更强的移植物抗白血病效应，从而使非缓解期复发和难治性急性髓系白血病（R/R AML）患者的复发率更低。本研究旨在调查与人类白细胞抗原匹配的相关供体移植（MRDT）相比，CBT的影响。本研究纳入了2451例非缓解期R/R AML成年患者，这些患者在2009年1月至2018年12月期间接受了CBT（1738例患者）或MRDT（713例患者）。使用倾向评分（PS）匹配分析评估了五年无进展生存期（PFS）和CBT的预后影响。PS匹配后，两组患者的特征得到了很好的平衡。CBT组的五年PFS为25.2%（95%置信区间[CI]：21.2 - 29.5%），MRDT组为18.1%（95%CI：14.5 - 22.0%）（P = 0.009）。调整后的风险比（HR）为0.83（95%CI：0.69 - 1.00，P = 0.045）；这是由于复发率下降更为明显（HR：0.78，95%CI：0.69 - 0.89，P < 0.001），而不是非复发死亡率增加（1.42，1.15 - 1.76，P = 0.001）。在这一人群中，异基因造血干细胞移植后，CBT与比MRDT更好的5年PFS相关。
