文章：

干细胞移植中供者选择的决策分析——HLA-8/8等位基因匹配的无血缘供者 vs HLA-1位点错配的有血缘供者

Decision analysis for donor selection in stem cell transplantation—HLA-8/8 allele-matched unrelated donor vs HLA-1 AG mismatched related donor

原文发布日期：2014-12-05

DOI: 10.1038/bcj.2014.85

类型: Original Article

开放获取: 是

英文摘要：

Risk of relapse during the unrelated donor coordination period biases comparisons between allogeneic hematopoietic stem cell transplantation from an HLA 8 of 8 allele-matched unrelated donor (8/8 MUD) and that from a related donor with an HLA-1 antigen mismatch in the graft-versus-host (GVH) direction (RD/1AGMM-GVH). To reduce this bias, we performed a decision analysis focusing on acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) in first complete remission (CR1). The primary outcome measure was 5-year survival probability with or without quality-of-life (QOL) adjustment. A baseline analysis showed that the decision to perform MUD transplantation was superior to that to perform RD/1AGMM-GVH transplantation for patients with AML or ALL. However, in the ALL cohort, the direction of superiority was reversed when the interval between CR1 and 8/8 MUD transplantation was >5.5 months (without QOL adjustment) or >6 months (after QOL adjustment) or when overall survival of RD/1AGMM-GVH transplantation improved by 1.3% without QOL adjustment and 2.1% after QOL adjustment. In conclusion, 8/8 MUD should be prioritized in transplantation for AML and ALL in CR1. However, the MUD coordination period and improvements in RD/1AGMM-GVH transplantation might change the donor selection priority in transplantation for ALL in CR1.

摘要翻译： 

在无关供者协调期间存在的复发风险会干扰以下两种移植方式的比较：一种来自HLA 8/8等位基因全相合无关供者（8/8 MUD）的异基因造血干细胞移植，另一种来自移植物抗宿主（GVH）方向存在HLA-1个抗原不合的相关供者（RD/1AGMM-GVH）。为减少此偏倚，我们针对首次完全缓解（CR1）的急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）进行了决策分析。主要结局指标是经生活质量调整或未调整的5年生存概率。基线分析显示，对AML或ALL患者而言，选择MUD移植优于RD/1AGMM-GVH移植。但在ALL队列中，当从CR1到8/8 MUD移植的间隔时间超过5.5个月（未调整QOL）或超过6个月（调整QOL），或当RD/1AGMM-GVH移植总生存率提升1.3%（未调整QOL）和2.1%（调整QOL）时，这种优势会发生逆转。综上所述，对于CR1期AML和ALL患者应优先选择8/8 MUD移植。但MUD协调周期的时间因素和RD/1AGMM-GVH移植疗效的提升可能会改变CR1期ALL患者的供者选择优先级。

原文链接：

Decision analysis for donor selection in stem cell transplantation—HLA-8/8 allele-matched unrelated donor vs HLA-1 AG mismatched related donor