Dini G, Lanino E, Lamparelli T, Barbanti M, Sacchi N, Carcassi C, Locatelli F, Porta F, Rosti G, Alessandrino E P, Aversa F, Marenco P, Guidi S, Uderzo C, Amoroso A, Di Bartolomeo P, Garbarino L, La Nasa G, Rossetti F, Miniero R, Soligo D, Manfredini L, Bacigalupo A
Department of Pediatric Hematology/Oncology, Istituto 'Giannina Gaslini', Genova, Italy.
Bone Marrow Transplant. 1996 Jan;17(1):55-62.
From 1 September 1988 to 30 September 1993, a search for an unrelated donor (URD) was started for 633 Italian patients. Eighty-five of them (13%) were transplanted. Despite the introduction of more strict criteria for the selection of compatible donors, the percentage of patients who reached transplant increased significantly after December 1992. For patients who started a search before and after January 1993, respectively the probability of transplant by 8 and 16 months from search activation was 4 and 10%, compared to 22 and 37% (P = 0.0001). The average intervals between search activation and graft were 15 and 8 months respectively, for the first and second group (P = 0.0001). Data of 75 consecutive transplants performed up to March 1994 were analyzed. Actuarial 2-year survival was 15% for patients grafted before 1992 and 40% for those grafted after January 1992. In this latter period, survival of patients with malignant and non-malignant disorders was 32 and 67%, respectively. In univariate analysis, patients younger than 16 years (P = 0.01), patients grafted after 1992 (P = 0.01) and patients receiving the marrow from a 6-antigen matched donor (P = 0.01) showed a higher survival probability. Multivariate analysis did not show any difference, probably due to the low number of patients and to short follow-up. The adoption of stricter and more accurate HLA-matching criteria and the consequent reduction of deaths related to acute GVHD were the main reasons for the improvement of survival observed in patients grafted after 1992.
1988年9月1日至1993年9月30日，为633名意大利患者启动了寻找无关供体（URD）的工作。其中85人（13%）接受了移植。尽管引入了更严格的选择匹配供体的标准，但1992年12月后达到移植的患者百分比显著增加。对于分别在1993年1月之前和之后开始寻找供体的患者，从寻找启动后8个月和16个月进行移植的概率分别为4%和10%，而之前这一概率为22%和37%（P = 0.0001）。第一组和第二组从寻找启动到移植的平均间隔分别为15个月和8个月（P = 0.0001）。分析了截至1994年3月进行的75例连续移植的数据。1992年之前接受移植的患者2年精算生存率为15%，1992年1月之后接受移植的患者为40%。在后一时期，患有恶性和非恶性疾病的患者生存率分别为32%和67%。单因素分析显示，年龄小于16岁的患者（P = 0.01）、1992年之后接受移植的患者（P = 0.01）以及接受6抗原匹配供体骨髓的患者（P = 0.01）的生存概率更高。多因素分析未显示任何差异，可能是由于患者数量较少且随访时间较短。采用更严格、更精确的HLA匹配标准以及随之减少与急性移植物抗宿主病相关的死亡是1992年之后接受移植患者生存率提高的主要原因。
