非血缘脐血移植与HLA相合同胞外周血干细胞移植治疗成人恶性血液病的对比研究

OBJECTIVE: To compare the efficacy of unrelated cord blood transplantation (UCBT) and HLA-identical sibling peripheral blood stem cell transplantation (PBSCT) for the treatment of adult hematological malignancies. METHODS: From April 2011 to December 2015, a total of 81 patients receiving single-unit UCBT and 57 patients receiving HLA-identical sibling PBSCT were enrolled in this study. All of the patients received myelablative conditioning. Cyclosporine combined with mycophenolate mofetil was adopted for GVHD prophylaxis. RESULTS: The cumulative incidence of neutropil engraftment at day-42 was 95.0% and 100% in UCBT and sibling PBSCT groups, respectively (P=0.863). Platelet engraftment at day 100 was 87.3% (95%CI 76.8%–93.1%) in UCBT group, which was significantly lower than that of sibling PBSCT group[98.2% (95%CI 87.3%–99.7%)] (P=0.005). There were no significant differences in terms of Ⅱ–Ⅳ acute GVHD or Ⅲ–Ⅳ acute GVHD in two groups (P=0.142, 0.521). The 3-year chronic GVHD and extensive chronic GVHD were 14.9% (95%CI 5.2%–23.5%) and 11.2% (95%CI 2.9%–18.7%), respectively in UCBT group, which was significantly lower than that of sibling PBSCT group[35.2% (95%CI 19.4%–47.8%), 31.4% (95%CI 16.2%–43.9%)] (P=0.008, 0.009). The 3-year transplant-related mortality (TRM) was similar between two groups (30.1% vs 23.2%, P=0.464). The relapse rate at 3-year in UCBT group[12.9% (95%CI 6.6%–21.5%)] was significantly lower than that in sibling PBSCT group[24.3% (95%CI 13.5%–36.8%)] (P=0.039). There were no significant differences in terms of overall survival (OS) and disease-free survival (DFS) between two groups (58.6% vs 54.8%, P=0.634; 57.0% vs 52.4%, P=0.563). But GVHD-free and relapse-free survival (GRFS) in UCBT group [55.7% (95%CI 44.1%–65.8%)] was significantly higher than that of sibling PBSCT group[42.9% (95%CI 29.8%–55.3%)] (P=0.047). CONCLUSION: For adult hematological malignancies, the incidences of acute GVHD and TRM were similar between UCBT and sibling PBSCT recipients, and the incidences of chronic GVHD and relapse were lower in UCBT recipients. UCBT recipients had higher GRFS rate although OS and DFS were similar between two groups, which may reflect the real recovery and better quality of life following UCBT.