Comparative retrospective analysis of cord blood transplantation with ATG-containing conditioning regimens and haploidentical stem cell transplantation: similar survival outcomes with reduced incidence of GVHD.
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Abstract
Background: Cord blood (CB) is widely used in treating haematologic disorders due to its broad availability, tolerance to significant histocompatibility antigen disparities, and low incidence of chronic graft-versus-host disease (cGVHD). The cord blood transplantation (CBT) with anti-thymocyte globulin (ATG)-containing conditioning regimens shows promise in this regard.
Methods: We conducted a retrospective review of data from patients who underwent CBT at our centre from August 2003 to December 2022. Patients undergoing CBT with ATG were matched with those who received HLA-haploidentical haematopoietic stem cell transplantation (haplo-HSCT). Propensity score matching (PSM) was utilized to form 105 matched pairs (140 patients) for comprehensive trial analysis.
Results: The cumulative incidence of neutrophil and platelet engraftment was significantly lower in the CBT group. Patients in the CBT group exhibited significantly lower incidences of grade II-IV acute GVHD (aGVHD) and cGVHD compared to the haplo-HSCT group (8.57% vs. 29.52%, p = 0.012; 20% vs. 39.05%, p = 0.031). The overall survival (OS) rate for the CBT and haplo-HSCT groups showed no significant difference. In patients with leukaemia, the CBT cohort showed better OS, GVHD-free and relapse-free survival (GRFS), as well as a lower incidence of disease relapse, although there was no statistical difference.
Conclusion: Our single-centre retrospective long-term follow-up investigations indicated that although the implantation rate of CBT is lower than that of haplo-HSCT, patients undergoing CBT with ATG-containing conditioning regimens may have a comparable overall survival with a lower risk of GVHD compared to those undergoing haplo-HSCT.
背景:脐带血(CB)由于其广泛的可用性、对组织相容性抗原差异的耐受性和慢性移植物抗宿主病(cGVHD)的低发病率而被广泛用于治疗血液病。脐带血移植(CBT)与抗胸腺细胞球蛋白(ATG)含调理方案在这方面显示出希望。方法:我们对2003年8月至2022年12月在本中心接受CBT治疗的患者数据进行了回顾性分析。接受CBT合并ATG的患者与接受hla -单倍体造血干细胞移植(haploi - hsct)的患者相匹配。采用倾向评分匹配(PSM),形成105对匹配对(140例)进行综合试验分析。结果:CBT组中性粒细胞和血小板累积发生率明显降低。CBT组患者II-IV级急性GVHD (aGVHD)和cGVHD的发生率明显低于单倍hsct组(8.57% vs 29.52%, p = 0.012;20% vs. 39.05%, p = 0.031)。CBT组和单倍hsct组的总生存率(OS)无显著差异。在白血病患者中,CBT队列表现出更好的OS,无gvhd和无复发生存(GRFS),以及更低的疾病复发率,尽管没有统计学差异。结论:我们的单中心回顾性长期随访研究表明,尽管CBT的植入率低于单倍hsct,但与单倍hsct相比,CBT患者与含atg调节方案的患者可能具有相当的总生存期和更低的GVHD风险。