Davies S M, Wagner J E, Weisdorf D J, Shu X O, Blazar B R, Enright H, McGlave P B, Ramsay N K
Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA.
Leuk Lymphoma. 1996 Oct;23(3-4):221-6. doi: 10.3109/10428199609054824.
We have explored the efficacy and toxicity of hematopoietic stem cell transplantation from unrelated donors for hematologic malignancies and other disorders. While most marrow donors have been identified through the National Marrow Donor Program in cooperation with many international registries, the recent development of unrelated donor umbilical cord blood (UCB) banks has allowed us to also evaluate this stem cell source. Analysis of the first 211 URD BMT performed at the University of Minnesota shows an overall survival of 33%, with older recipient age and transplant from a donor with a major HLA-A or B mismatch independently associated with poorer survival. Analysis of engraftment of URD marrow shows increasing risk of delayed or incomplete engraftment with increasing HLA disparity between URD and recipient. GVHD is increased in recipients of URD marrow compared with recipients of related donor marrow. Malignant relapse, however, is less frequent in URD marrow recipients, perhaps due to an increased graft-versus-leukemia effect. Formal assessment shows quality of life in long term URD BMT survivors (beyond 2 years) is excellent, and not different from that seen in sibling marrow recipients. Data from patients receiving unrelated donor UCB transplantation at the University of Minnesota indicate that UCB is an acceptable alternate source of stem cells, at least for young recipients, and may be associated with a reduced incidence of GVHD. Ongoing studies at the University of Minnesota include examination of the applicability of unrelated UCB transplantation to adult recipients, and of the degree of HLA-incompatibility which can be tolerated in UCB transplantation. Studies to identify the optimal GVHD prophylaxis for URD BMT, and to examine the role of class II matching in transplant outcome are in progress.
我们探讨了非血缘供者造血干细胞移植治疗血液系统恶性肿瘤及其他疾病的疗效和毒性。虽然大多数骨髓供者是通过国家骨髓供者计划与许多国际登记处合作确定的，但非血缘供者脐带血（UCB）库的最新发展使我们能够评估这种干细胞来源。对明尼苏达大学进行的首例211例非血缘供者骨髓移植（URD BMT）的分析显示，总生存率为33%，受者年龄较大以及接受与供者主要HLA - A或B位点不匹配的移植与较差的生存率独立相关。对URD骨髓植入情况的分析表明，随着URD与受者之间HLA差异的增加，延迟或不完全植入的风险也在增加。与血缘供者骨髓受者相比，URD骨髓受者的移植物抗宿主病（GVHD）有所增加。然而，URD骨髓受者的恶性肿瘤复发频率较低，这可能是由于移植物抗白血病效应增强。正式评估显示，长期（超过2年）URD BMT幸存者的生活质量良好，与同胞骨髓受者无异。明尼苏达大学接受非血缘供者UCB移植患者的数据表明，UCB是一种可接受的干细胞替代来源，至少对于年轻受者是如此，并且可能与GVHD发生率降低有关。明尼苏达大学正在进行的研究包括检查非血缘UCB移植对成年受者的适用性，以及UCB移植中可耐受的HLA不相容程度。确定URD BMT最佳GVHD预防措施以及研究II类配型在移植结果中的作用的研究正在进行中。
