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在有微小残留病的患者中进行脐带血移植
Cord-Blood Transplantation in Patients with Minimal Residual Disease


Filippo Milano ... 肿瘤 其他 • 2016.09.08

供者选择:人人都有供者时代的热点问题


黄晓军

北京大学人民医院,北京大学血液病研究所,造血干细胞移植治疗血液病北京市重点实验室,北大-清华生命中心


替代供者包括单倍型造血干细胞移植、非血缘造血干细胞及脐血造血干细胞移植的进展,使造血干细胞移植进入人人都有供者的新时代,供者优选原则已成为造血干细胞移植应用领域的热点问题1-3。多项国际指南包括美国、欧洲及我国,均建议先选非血缘供者,尤其是HLA相合非血缘供者,然后才考虑脐血供者。

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摘要


背景

大部分需要进行造血细胞移植的患者都没有匹配的亲缘性供体。我们需要数据支持以对各种备选的供体细胞来源进行选择。

 

方法

在这项回顾性分析中,我们对582名连续治疗的急性白血病或骨髓增生异常综合征患者的结局进行比较,这些患者接受了来自非亲缘性脐带血供体(140例患者)、HLA匹配的非亲缘性供体(344例患者)或HLA不匹配的非亲缘性供体(98例患者)的首次清髓性造血细胞移植。

 

结果

脐带血组与其他两个非亲缘性供体组之间死亡和复发的相对风险,根据移植前微小残留病的存在状况而各不相同。在有微小残留病的患者中,HLA不匹配组的死亡风险高于脐带血组(风险比为2.92;95%可信区间[CI],1.52~5.63;P=0.001);HLA匹配组的风险也高于脐带血组,但没有显著性差异(风险比为1.69;95% CI,0.94~3.02;P=0.08)。没有微小残留病的患者风险比较低(HLA不匹配组的风险比为1.36;95% CI,0.76~2.46;P=0.30;HLA匹配组的风险比为0.78;95% CI,0.48~1.28;P=0.33)。两个非亲缘性供体组中有微小残留病患者的复发风险显著高于脐带血组(HLA不匹配组的风险比为3.01;95% CI,1.22~7.38;P=0.02;HLA匹配组的风险比为2.92;95% CI,1.34~6.35;P=0.007)。在没有微小残留病的患者中,关联性强度较低(HLA不匹配组的风险比为1.28;95% CI,0.51~3.25;P=0.60;HLA匹配组的风险比为1.30;95% CI,0.65~2.58;P=0.46)。

 

结论

我们的数据显示,在移植前存在微小残留病的患者中,接受脐带血供体移植后的总体存活概率与接受HLA匹配的非亲缘性供体移植相比至少相当,并显著高于接受HLA不匹配的非亲缘性供体移植后的存活概率。而且,脐带血组的复发概率低于其他任何一组。





作者信息

Filippo Milano, M.D., Ph.D., Ted Gooley, Ph.D., Brent Wood, M.D., Ann Woolfrey, M.D., Mary E. Flowers, M.D., Kristine Doney, M.D., Robert Witherspoon, M.D., Marco Mielcarek, M.D., Joachim H. Deeg, M.D., Mohamed Sorror, M.D., Ann Dahlberg, M.D., Brenda M. Sandmaier, M.D., Rachel Salit, M.D., Effie Petersdorf, M.D., Frederick R. Appelbaum, M.D., and Colleen Delaney, M.D.
From the Clinical Research Division, Fred Hutchinson Cancer Research Center (F.M., T.G., A.W., M.E.F., K.D., R.W., M.M., J.H.D., M.S., A.D., B.M.S., R.S., E.P., F.R.A., C.D.), and the Departments of Medicine (F.M., B.W., M.E.F., M.M., J.H.D., M.S., B.M.S., R.S., E.P., F.R.A.) and Pediatrics (A.W., A.D., C.D.), University of Washington — both in Seattle. Address reprint requests to Dr. Milano at the Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MD-B306, Seattle, WA 98109, or at fmilano@redhutch.org.

 

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