Matsumoto K, Horibe K, Akatsuka Y, Minami S, Matsuyama T, Hirabayashi N, Tanimoto M, Yamada H, Sobue R, Morishima Y
Department of Pediatrics, Nagoya University School of Medicine.
Rinsho Ketsueki. 1994 Aug;35(8):729-37.
One hundred and fourteen patients with hematological malignancies received bone marrow transplantation from donors other than HLA-identical siblings. Sixty-three patients received transplantations from related donors; 20 were phenotypically identical for HLA-A, B, D/DR (RM0). 32 differed at one locus (RM1) and 11 differed at more than one loci (RM2). Fifty-one transplantations were from unrelated donors; 37 were phenotypically identical and mixed lymphocyte culture (MLC) negative (UR0) and 14 were MLC positive (UR1). One hundred and four patients had durable engraftment. Four (RM1(1), RM2(2), UR0(1)) failed to achieve engraftment. In terms of the probability of > or = Grade II acute graft-versus-host disease (GVHD), there was no significant difference among the groups according to HLA disparity (RM0:25%, UR0:33%, UR1:39%, RM1:47%, and RM2:50%). The probability of chronic GVHD was significantly higher in UR0 and UR1 than RM0 (71%, 75% vs 28%, p < 0.05). The disease-free survival at 3 years was 45% (RM0), 50% (RM1) and 42% (UR0). More than 50% of patients other than RM0 died of fatal complications including GVHD within 60 days after grafting. In conclusion, unrelated donor and related donor mismatched at one locus could be selected for marrow graft in the case of the absence of an HLA-matched related donor. However, more advances in post-transplant management and in histocompatibility testing should be required.
114例血液系统恶性肿瘤患者接受了非HLA完全相同同胞供者的骨髓移植。63例患者接受了相关供者的移植；20例患者的HLA - A、B、D/DR表型完全相同（RM0）。32例在一个位点存在差异（RM1），11例在多个位点存在差异（RM2）。51例移植来自无关供者；37例表型相同且混合淋巴细胞培养（MLC）阴性（UR0），14例MLC阳性（UR1）。104例患者实现了持久植入。4例（RM1(1)、RM2(2)、UR0(1)）未实现植入。就≥Ⅱ级急性移植物抗宿主病（GVHD）的发生率而言，根据HLA差异分组，各组之间无显著差异（RM0：25%，UR0：33%，UR1：39%，RM1：47%，RM2：50%）。UR0和UR1组慢性GVHD的发生率显著高于RM0组（71%，75%对28%，p<0.05）。3年无病生存率分别为45%（RM0）、50%（RM1）和42%（UR0）。除RM0组外，超过50%的患者在移植后60天内死于包括GVHD在内的致命并发症。总之，在没有HLA匹配的相关供者的情况下，可以选择一个位点不匹配的无关供者和相关供者进行骨髓移植。然而，移植后管理和组织相容性检测仍需取得更多进展。
