The First Affiliated Hospital of Soochow University, Jiangsu Institute of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Collaborative Innovation Center of Hematology, Suzhou, China.
Department of Hematology, Haikou Municipal People's Hospital, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China.
Front Immunol. 2022 Jun 23;13:912917. doi: 10.3389/fimmu.2022.912917. eCollection 2022.
The purpose of this study in severe aplastic anemia (SAA) patients was to compare the feasibility and efficacy of haploidentical hematological stem cell transplantation combined with a single unrelated cord blood (UCB) infusion (Haplo-cord-HSCT) or haplo-identical HSCT (Haplo-HSCT) alone. The five-year graft-versus-host disease (GVHD)-free or failure-free survival (GFFS) was similar between the two groups (72.4 ± 3.4% vs. 65.4 ± 5.2%, P = 0.178); however, the five-year overall survival (OS) was more favorable in the Haplo-cord-HSCT group than that in the Haplo-HSCT group (84.0 ± 2.8% vs. 72.6 ± 4.9%, P = 0.022), as was transplantation-related mortality (16.4% vs. 27.4%, P = 0.039). Multivariate analysis showed that Haplo-cord HSCT was the only independent determinant of increased OS (P = 0.013). Explorative subgroup analysis showed that only an Human leukocyte antigen-A (HLA-A) allele match between UCB and the recipient was a beneficial factor for GFFS in the Haplo-cord-HSCT group (P = 0.011). In the haplo-cord with an HLA-A match (n = 139) or mismatch (n = 32) or Haplo-HSCT groups, a haplo-cord HLA-A allele match was associated with lower I-IV and III-IV acute GVHD. The haplo-cord with an HLA-A match subgroup also had higher five-year OS than the Haplo-HSCT group (85.4 ± 3.0% vs. 72.6 ± 4.9%, P = 0.013), and higher five-year GFFS than the Haplo-cord HLA-A allele mismatch subgroup (76.2 ± 3.6% vs. 56.3 ± 8.8%, P = 0.011). These findings suggest that the coinfusion of a single UCB potentially improves survival of Haplo-HSCT in SAA patients and that an HLA-A allele-matched UCB is the preferred option.
本研究旨在比较重型再生障碍性贫血（SAA）患者采用单份无关脐血（UCB）输注联合haploidentical 造血干细胞移植（haplo-cord-HSCT）与单纯 haplo-identical HSCT（haplo-HSCT）的可行性和疗效。两组间 5 年无移植物抗宿主病（GVHD）或无失败生存（GFFS）率相似（72.4%±3.4% vs. 65.4%±5.2%，P=0.178），但haplo-cord-HSCT 组的 5 年总生存（OS）优于 haplo-HSCT 组（84.0%±2.8% vs. 72.6%±4.9%，P=0.022），移植相关死亡率也较低（16.4% vs. 27.4%，P=0.039）。多因素分析显示，haplo-cord HSCT 是 OS 增加的唯一独立决定因素（P=0.013）。探索性亚组分析显示，仅 UCB 与受者 HLA-A 等位基因匹配是 haplo-cord-HSCT 组 GFFS 的有益因素（P=0.011）。在 haplo-cord 与 HLA-A 匹配（n=139）或不匹配（n=32）或 haplo-HSCT 组中，haplo-cord HLA-A 等位基因匹配与较低的 I-IV 和 III-IV 级急性 GVHD 相关。haplo-cord HLA-A 等位基因匹配亚组的 5 年 OS 也高于 haplo-HSCT 组（85.4%±3.0% vs. 72.6%±4.9%，P=0.013），5 年 GFFS 也高于 haplo-cord HLA-A 等位基因不匹配亚组（76.2%±3.6% vs. 56.3%±8.8%，P=0.011）。这些发现表明，单份 UCB 的共输注可能改善 SAA 患者 haplo-HSCT 的生存，且 HLA-A 等位基因匹配的 UCB 是首选。
