Single-unit unrelated cord blood transplantation versus HLA-matched sibling transplantation in adults with advanced myelodysplastic syndrome: A registry-based study from the adult MDS working group of the Japanese society for transplantation and cellular therapy

IF 3.3 4区 医学 Q2 HEMATOLOGY
Takaaki Konuma, Hidehiro Itonaga, Yoshimitsu Shimomura, Machiko Fujioka, Kazunari Aoki, Naoyuki Uchida, Makoto Onizuka, Atsushi Jinguji, Masatsugu Tanaka, Yasunori Ueda, Yuta Katayama, Masashi Sawa, Haruyuki Tanaka, Hirohisa Nakamae, Toshiro Kawakita, Yumiko Maruyama, Satoshi Takahashi, Fumihiko Ishimaru, Junya Kanda, Tatsuo Ichinohe, Yoshiko Atsuta
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引用次数: 0

Abstract

Allogeneic hematopoietic stem cell transplantation (HCT) remains the only potential curative therapeutic modality for advanced myelodysplastic syndrome (MDS). Within HCT, the advancement of cord blood transplantation (CBT) procedures has resulted in a drastic expansion of CBT as a donor source for MDS. However, data comparing matched sibling donors (MSDs) HCT with CBT for advanced MDS, which was defined as refractory anemia with an excess of blasts (RAEB)-1 and RAEB-2 according to the World Health Organization classification at the time of HCT, have not been explored. We retrospectively compared survival and other posttransplant outcomes in 999 adult patients with advanced MDS after receiving allogeneic HCT in Japan between 2011 and 2020, using either MSD (n = 331) or single-unit unrelated cord blood (UCB) (n = 668). In the multivariate analysis, there were no significant differences in overall survival (hazard ratio [HR], 1.10; 95% confidence interval [CI], 0.90–1.34; P = 0.347), disease-free survival (HR, 1.01; 95% CI, 0.84–1.23; P = 0.845), relapse (HR, 0.88; 95% CI, 0.68–1.15; P = 0.370), or non-relapse mortality (HR, 1.15; 95% CI, 0.87–1.50; P = 0.310) between MSD recipients and UCB recipients. UCB was significantly associated with lower neutrophil (HR, 0.28; 95% CI, 0.24–0.33; P < 0.001) and lower platelet (HR, 0.29; 95% CI, 0.23–0.36; P < 0.001) recovery compared to MSD. UCB was significantly associated with a lower incidence of chronic graft-versus-host disease (GVHD) (HR, 0.57; 95% CI, 0.44–0.75; P < 0.001) and extensive chronic GVHD (HR, 0.46; 95% CI, 0.32–0.67; P < 0.001) compared to MSD. Similar results were observed after adjusting for differences between MSD and UCB recipients by propensity score matching analysis. Our study demonstrated that single CBT and MSD HCT had similar survival outcomes for adult patients with advanced MDS despite the lower hematopoietic recovery in CBT recipients and higher chronic GVHD in MSD recipients.

Abstract Image

晚期骨髓增生异常综合征成人患者的单份非亲缘脐带血移植与 HLA 匹配的兄弟姐妹移植:日本移植与细胞治疗学会成人骨髓增生异常综合征工作组基于登记的研究。
异基因造血干细胞移植(HCT)仍是晚期骨髓增生异常综合症(MDS)唯一可能治愈的治疗方式。在造血干细胞移植中,脐带血移植(CBT)程序的发展使脐带血移植作为MDS供体来源的范围急剧扩大。然而,对于晚期 MDS(根据 HCT 时世界卫生组织的分类,晚期 MDS 被定义为难治性贫血伴破泡细胞过多(RAEB)-1 和 RAEB-2),匹配同胞供者(MSDs)HCT 与 CBT 的比较数据尚未进行探讨。我们回顾性比较了 2011 年至 2020 年间在日本接受异基因 HCT 的 999 例晚期 MDS 成年患者的生存率和其他移植后预后,使用的是 MSD(n = 331)或单单位非亲缘脐带血(UCB)(n = 668)。在多变量分析中,总生存期(危险比 [HR],1.10;95% 置信区间 [CI],0.90-1.34;P = 0.347)、无病生存期(HR,1.01;95% CI,0.84-1.23;P = 0.845)、复发(HR,0.88;95% CI,0.68-1.15;P = 0.370)或非复发死亡率(HR,1.15;95% CI,0.87-1.50;P = 0.310)。UCB 与较低的中性粒细胞明显相关(HR,0.28;95% CI,0.24-0.33;P = 0.310)。
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来源期刊
Hematological Oncology
Hematological Oncology 医学-血液学
CiteScore
4.20
自引率
6.10%
发文量
147
审稿时长
>12 weeks
期刊介绍: Hematological Oncology considers for publication articles dealing with experimental and clinical aspects of neoplastic diseases of the hemopoietic and lymphoid systems and relevant related matters. Translational studies applying basic science to clinical issues are particularly welcomed. Manuscripts dealing with the following areas are encouraged: -Clinical practice and management of hematological neoplasia, including: acute and chronic leukemias, malignant lymphomas, myeloproliferative disorders -Diagnostic investigations, including imaging and laboratory assays -Epidemiology, pathology and pathobiology of hematological neoplasia of hematological diseases -Therapeutic issues including Phase 1, 2 or 3 trials as well as allogeneic and autologous stem cell transplantation studies -Aspects of the cell biology, molecular biology, molecular genetics and cytogenetics of normal or diseased hematopoeisis and lymphopoiesis, including stem cells and cytokines and other regulatory systems. Concise, topical review material is welcomed, especially if it makes new concepts and ideas accessible to a wider community. Proposals for review material may be discussed with the Editor-in-Chief. Collections of case material and case reports will be considered only if they have broader scientific or clinical relevance.
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