Matched-sibling donor versus unrelated umbilical cord blood transplantation for treating hematological
malignancies in children

doi:10.3969/j.issn.2095-4344.2062

Abstract

Abstract:

BACKGROUND: In recent years, umbilical cord blood has gradually become a crucial alternative source of stem cells for related and unrelated bone marrow or peripheral blood hematopoietic stem cell transplantation, which is increasingly used in the treatment of hematological malignancies in children.

OBJECTIVE: To compare the clinical efficacy of sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation for treating hematological malignancies in children.

METHODS: The clinical data of children with hematological malignancies who received umbilical cord blood transplantation at the Hematopoietic Stem Cell Transplantation Center of the First Affiliated Hospital of Zhengzhou University between January 1, 1998 and December 31, 2018 was retrospectively analyzed. All the patients received myelablative conditioning regimen, and cyslosporine A combined with or without mycophenolate mofetil were concurrently adopted for graft-versus-host disease prophylaxis.

RESULTS AND CONCLUSION: (1) Two patients in the sibling donor umbilical cord blood transplantation group and three in the unrelated umbilical cord blood transplantation group did not attain hematological engraftment and subsequently died from infection, and other patients succeeded in hematological engraftment. The median time of neutrophil and platelet engraftment in the sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups was [17 days (11-43 days), 18 days (12-45 days), P=0.307] and [20.5 days (15-50 days), 27 days (18-56 days), P=0.773]. There was no significant difference between the two groups. (2) The incidence of acute graft-versus-host disease and chronic graft-versus-host disease in the sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups was 36% vs. 43% (P=0.737) and 15% vs. 33% (P=0.412). There was no significant difference between the two groups. There was also no significant difference in the incidence of infection after transplantation between sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups (56% vs. 71%, P=0.343). (3) There were no significant differences in the 2-year overall survival (61% vs. 36%, P=0.301), or 2-year relapse-free survival (56% vs. 33%, P=0.151). The 5-year overall survival and 5-year relapse-free survival in the sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation groups were 54% vs. 24% (P=0.044) and 50% vs. 20% (P=0.039). The results showed that there was a significant difference in long-term survival rate between two groups. (4) Our results reveal that both sibling donor umbilical cord blood transplantation and unrelated umbilical cord blood transplantation are safe, effective and applicable for children with hematological malignancies. In particular, there are significant benefits in the long-term survival of substitute donor transplantation for pediatric patients with hematological malignancies.

Key words:

umbilical cord blood transplantation, matched-sibling, matched unrelated, hematological malignancies, long-term survival, graft-versus-host disease, hematological engraftment, overall survival, relapse-free survival

CLC Number:

Qin Yang, Wan Dingming, Cao Weijie, Zhang Suping, Li Li, Zhang Ran, Song Yongping, Zhang Yanli, Wang Dao. Matched-sibling donor versus unrelated umbilical cord blood transplantation for treating hematological malignancies in children[J]. Chinese Journal of Tissue Engineering Research, 2020, 24(13): 1969-1975.

Figures/Tables 6

2.6 急慢性移植物抗宿主病发生情况在分析急性移植物抗宿主病及慢性移植物抗宿主病的发生情况时，分别参照西雅图国际标准对于急性移植物抗宿主病及慢性移植物抗宿主病进行评分及各脏器分级。在该研究中，同胞脐血移植组有2例患者在移植后造血重建前死于严重感染，非血缘脐血移植组有3例患者在移植后造血重建前死于严重感染，故在分析急性移植物抗宿主病的发生率时，应去除造血重建前早期死亡患者，即同胞脐血移植组急性移植物抗宿主病发生率为35%(5/14)，非血缘脐血移植组急性移植物抗宿主病发生率为43%(9/21)。在分析慢性移植物抗宿主病的发生情况时，可统计患者应该是随访时间超过100 d的患者，100 d内死亡及造血重建前死亡患者应排除，故可分析病例数有所改变。在该研究中，同胞脐血移植组有2例患者在移植后造血重建前死于严重感染，1例患者在100 d内死亡，即同胞脐血移植组慢性移植物抗宿主病发生率为15%(2/13)，非血缘脐血移植组有3例患者在移植后造血重建前死于严重感染，3例患者在100 d内死亡，即非血缘脐血移植组慢性移植物抗宿主病发生率为33%(6/18)。结果显示两组急性移植物抗宿主病及慢性移植物抗宿主病的发生率差异均无显著性意义，见表2。 2.7 总体生存率及无复发生存率所有患者中位随访时间为11个月(1-246个月)，2年总体生存率及2年无复发生存率分别为47%，38%。同胞脐血移植组与非血缘脐血移植组相比，移植后中位随访时间分别为26.5个月(3-246个月)，8个月(1-187个月)(P=0.012)，两组移植后随访时间差异有显著性意义，见表2。2年总体生存率分别为61%，36%(P=0.301)，2年无复发生存率分别为56%，33% (P=0.151)；5年总体生存率分别为54%，24%(P=0.044)，5年无复发生存率分别为50%，20%(P=0.039)，见图2，3。同胞脐血移植组与非血缘脐血移植组在长期生存方面差异有显著性意义。 "

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