Locatelli F, Rocha V, Chastang C, Arcese W, Ortega J, Pasquini R, Souillet G, Ferreira E, Comoli P, Gluckman E
Clinica Pediatrica, Università di Pavia, IRCCS Policlinico San Matteo, Italy.
Bone Marrow Transplant. 1998 Jun;21 Suppl 3:S63-5.
Over the past decade, allogeneic cord blood transplantation (CBT) has been widely used for treating patients with malignant disorders. However, the reported low incidence of GVHD observed after allogeneic CBT might be a major drawback in leukemic recipients and at present it is not clear whether CBT really predisposes patients to an increased risk of leukemia relapse. In order to further elucidate the role of CBT in children with hematological malignancies, 54 patients with ALL or AML given either a related (31 cases) or an unrelated (23 cases) CBT in 25 centers participating in the Eurocord Registry were analyzed. Overall survival of related and unrelated CBT recipients was substantially similar, the most important factor influencing patients' outcome being disease state at time of transplantation. In fact, due to a markedly increased relapse rate, poor-risk children (ie patients transplanted in more advanced disease) experienced a significantly worse EFS than those given CBT in a more favorable disease phase (ie CR1 or CR2). These data confirm that allogeneic CBT from either a related or an unrelated donor is a feasible procedure able to cure a significant proportion of children with acute leukemia, especially if transplanted in a favorable phase of disease.
在过去十年中，异基因脐血移植（CBT）已被广泛用于治疗恶性疾病患者。然而，报道显示异基因CBT后观察到的移植物抗宿主病（GVHD）发生率较低，这可能是白血病受者的一个主要缺点，目前尚不清楚CBT是否真的会使患者白血病复发风险增加。为了进一步阐明CBT在血液系统恶性肿瘤儿童中的作用，对参与欧洲脐血库登记处的25个中心接受相关（31例）或无关（23例）CBT的54例急性淋巴细胞白血病（ALL）或急性髓细胞白血病（AML）患儿进行了分析。相关和无关CBT受者的总生存率基本相似，影响患者预后的最重要因素是移植时的疾病状态。事实上，由于复发率显著增加，高危儿童（即在疾病更晚期接受移植的患者）的无事件生存率（EFS）明显低于在疾病更有利阶段（即完全缓解1期或完全缓解2期）接受CBT的儿童。这些数据证实，来自相关或无关供体的异基因CBT是一种可行的方法，能够治愈相当比例的急性白血病儿童，特别是在疾病的有利阶段进行移植时。
