Department of Hematology, National Defense Medical College Hospital, Saitama, Japan; Department of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Department of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Transplant Cell Ther. 2022 Aug;28(8):504.e1-504.e7. doi: 10.1016/j.jtct.2022.05.006. Epub 2022 May 13.
Because cord blood (CB) units are usually selected based on the cell dose per kilogram, overweight (body mass index [BMI] ≥25 kg/mto < 30 kg/m) and obese (30 kg/m ≤ BMI) recipients tend to have difficulty in getting appropriate CB units. In general, actual body weight (ABW) is used for CB unit selection. However, ideal body weight (IBW) has been reported to be more closely correlated with successful engraftment after autologous, allogeneic bone marrow, and peripheral blood stem cell transplantation than ABW. We conducted this analysis to clarify the threshold of CD34 cell doses based on ideal body weight (CD34) and to compare the outcomes among the groups stratified by the threshold according to actual body weight (CD34) and CD34 for overweight and obese recipients in cord blood transplantation (CBT). We retrospectively analyzed 650 overweight and obese recipients who received single-unit CBT. To focus on the recipients who received a low CD34 cell dose/kg, those who received 1.5×10 CD34 cells/ABW or more were excluded. Using a cut-off of 0.8×10 CD34 cells/kg, we compared the outcomes in 3 groups with low CD34 and low CD34 (CD34), low CD34 but high CD34 (CD34), and high CD34 and high CD34 (CD34). Hematopoietic recoveries were significantly delayed in the CD34 group compared with those in the CD34 group (hazard ratio [HR] 0.67 for neutrophil, P < .001; HR 0.72 for platelet, P = .014), whereas those were comparable in the CD34 and CD34 groups (HR 1.22 for neutrophil, P = .16; HR 1.29 for platelet, P = .088). Moreover, the CD34 group demonstrated longer overall survival than the CD34 group (HR 1.48, P = .011) and comparable survival to the CD34 group (HR 0.93, P = .68). This finding may address the lack of availability of CB units for some overweight and obese recipients for whom suitable donors are unavailable. Further investigations are warranted to evaluate the appropriateness of ABW and IBW.
由于脐带血（CB）单位通常基于每公斤的细胞剂量进行选择，超重（体重指数[BMI]≥25 kg/m 至 <30 kg/m）和肥胖（30 kg/m≤BMI）的受者往往难以获得合适的 CB 单位。通常，实际体重（ABW）用于 CB 单位选择。然而，已经报道理想体重（IBW）与自体、同种异体骨髓和外周血造血干细胞移植后的成功植入更为密切相关，而不是 ABW。我们进行了这项分析，以阐明基于理想体重（CD34）的 CD34 细胞剂量阈值，并比较根据 ABW 和 CD34 对超重和肥胖 CB 移植（CBT）受者进行分组的阈值的各组之间的结果。我们回顾性分析了 650 名接受单单位 CBT 的超重和肥胖受者。为了关注接受低 CD34 细胞剂量/公斤的受者，排除了那些接受 1.5×10 CD34 细胞/ABW 或更多的受者。使用 0.8×10 CD34 细胞/kg 的截止值，我们比较了低 CD34 和低 CD34（CD34）、低 CD34 但高 CD34（CD34）和高 CD34 且高 CD34（CD34）三组的结果。与 CD34 组相比，CD34 组的造血恢复明显延迟（中性粒细胞的危险比[HR]0.67，P<.001；血小板的 HR 0.72，P=.014），而 CD34 组和 CD34 组的恢复相似（中性粒细胞的 HR 1.22，P=.16；血小板的 HR 1.29，P=.088）。此外，CD34 组的总生存时间长于 CD34 组（HR 1.48，P=.011），与 CD34 组的生存时间相当（HR 0.93，P=.68）。这一发现可能解决了一些超重和肥胖受者缺乏合适 CB 单位的问题，对于这些受者，合适的供者无法获得。需要进一步的研究来评估 ABW 和 IBW 的适宜性。
