Matsuda Kensuke, Konuma Takaaki, Fuse Kyoko, Masuko Masayoshi, Kawamura Koji, Hirayama Masahiro, Uchida Naoyuki, Ikegame Kazuhiro, Wake Atsushi, Eto Tetsuya, Doki Noriko, Miyakoshi Shigesaburo, Tanaka Masatsugu, Takahashi Satoshi, Onizuka Makoto, Kato Koji, Kimura Takafumi, Ichinohe Tatsuo, Takayama Nobuyuki, Kobayashi Hikaru, Nakamae Hirohisa, Atsuta Yoshiko, Kanda Junya, Yanada Masamitsu
Department of Haematology and Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Haematology and Oncology, JR Tokyo General Hospital, Tokyo, Japan.
Br J Haematol. 2023 Apr;201(1):106-113. doi: 10.1111/bjh.18530. Epub 2022 Oct 25.
Allogeneic haematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for some patients with acute myeloid leukaemia (AML) who are refractory to chemotherapy. Cord blood transplantation (CBT) is a reasonable option in such cases because of its rapid availability. Recently, a growing number of human leucocyte antigen (HLA)-haploidentical related donor HSCTs (haplo-HSCTs) have been performed, although its effectiveness remains undetermined. Using the Japanese nationwide transplantation registry data, we identified 2438 patients aged ≥16 years who received CBT or haplo-HSCT as their first transplant for non-remission AML between January 2008 and December 2018. After 2:1 propensity score matching, 918 patients in the CBT group and 459 patients in the haplo-HSCT group were selected. In this matched cohort, no significant difference in overall survival (OS) was observed between the CBT and haplo-HSCT groups (hazard ratio [HR] of haplo-HSCT to CBT 1.02, 95% confidence interval [CI] 0.89-1.16). Similarly, no significant difference in the cumulative incidence of relapse (HR 1.09, 95% CI 0.93-1.28) or non-relapse mortality (HR 0.94, 95% CI 0.76-1.18). Subgroup analysis showed that CBT was significantly associated with preferable OS in patients receiving myeloablative conditioning. Our data showed comparable outcomes between haplo-HSCT and CBT recipients with non-remission AML.
异基因造血干细胞移植（HSCT）对于一些化疗难治的急性髓系白血病（AML）患者而言是一种具有潜在治愈可能的治疗方法。在这种情况下，脐带血移植（CBT）因其可快速获取而成为一种合理选择。最近，尽管人类白细胞抗原（HLA）半相合相关供者HSCT（单倍体HSCT）的有效性仍未确定，但此类移植的实施数量日益增多。利用日本全国移植登记数据，我们确定了2438例年龄≥16岁的患者，这些患者在2008年1月至2018年12月期间接受CBT或单倍体HSCT作为首次移植，用于治疗未缓解的AML。经过2:1倾向评分匹配后，选择了CBT组中的918例患者和单倍体HSCT组中的459例患者。在这个匹配队列中，CBT组和单倍体HSCT组之间的总生存期（OS）未观察到显著差异（单倍体HSCT与CBT的风险比[HR]为1.02，95%置信区间[CI]为0.89 - 1.16）。同样，复发累积发生率（HR 1.09，95% CI 0.93 - 1.28）或非复发死亡率（HR 0.94，95% CI 0.76 - 1.18）也没有显著差异。亚组分析显示，在接受清髓性预处理的患者中，CBT与较好的OS显著相关。我们的数据表明，未缓解AML患者接受单倍体HSCT和CBT的结果具有可比性。
