比较脐血与非血缘不全相合供者移植对恶性血液病疗效的Meta分析  

A meta-analysis of unrelated cord blood transplantation versus HLA-mismatched unrelated donor transplantation in hematological malignancies

作　　者：苏文思 袁娇娇[1] 陆滢 

机构地区：[1]宁波大学医学院,浙江宁波315000 [2]宁波大学医学院附属鄞州人民医院血液科,浙江宁波315000

出　　处：《临床荟萃》2018年第3期244-250,共7页Clinical Focus

基　　金：浙江省医药卫生科技项目(2017KY144)

摘　　要：目的分析和比较非血缘脐血干细胞移植(unrelated cord blood transplantation,UCBT)和人类白细胞抗原不全相合非血缘供者移植(human leukocyte antigen-mismatched unrelated donor transplantation,HLAMMUDT)对成人恶性血液病的疗效及预后。方法计算机检索PubMed、EMBASE、Cochrane图书馆的临床对照试验数据库(CENTRAL)、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库、维普数据库(VIP),并对纳入文献的参考文献进行扩大检索。采用RevMan 5.3软件进行统计分析。结果共纳入7篇文献,包含1 275例接受UCBT治疗患者及751例接受MMUDT治疗患者。Meta分析结果显示,UCBT组的急、慢性移植物抗宿主病的发生率均低于MMUDT组(RR=0.89,95%CI=0.80~0.99,P=0.03;RR=0.63,95%CI=0.50~0.79,P<0.01),感染相关病死率高于MMUDT组(RR=1.23,95%CI=1.05~1.46,P=0.01),但是两组的复发率、移植相关病死率、总体生存率、无病生存率差异无统计学意义(RR=0.85,95%CI=0.65~1.11,P=0.23;RR=0.95,95%CI=0.78~1.17,P=0.51;HR=1.01,95%CI=0.90~1.13,P=0.87;HR=1.04,95%CI=0.91~1.20,P=0.56)。结论对于成人高度恶性血液疾病,未找到全相合血缘和非血缘关系供者而言,脐血移植及不全相合非血缘供者移植可作为一种有效的治疗方法。MMUDT对于感染风险较大、缺乏全相合供者的患者较UCBT有一定的优势。Objective To compare the efficacy of unrelated cord blood transplantation(UCBT)and human leukocyte antigen mismatched unrelated donor transplantation(HLA-MMUDT)in treatment of adult hematological malignancies.Methods Published studies of UCBT and MMUDT were collected from PubMed,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)of the Cochrane Library,China Biology Medicine(CBM),China National Knowledge Infrastructure(CNKI),WANFANG database and VIP information.References of retrieved articles were also identified.Data analysis was performed with RevMan 5.3.Results Seven studies were selected,which included 1 275 patients treated with UCBT and 751 patients treated with MMUDT.Meta-analysis results showed that the incidence of acute graft-versus-host disease and chronic graft-versus-host disease in UCBT group was significantly lower than MMUDT group(RR =0.89,95%CI =0.80-0.99,P =0.03;RR =0.63,95%CI =0.50-0.79,P <0.01).However,infection-related mortality in UCBT group was significantly higher than MMUDT group(RR =1.23,95%CI =1.05-1.46,P =0.01).There was no significant difference in relapse,transplantation-related mortality,overall survival and disease free survival between two groups,respectively(RR =0.85,95%CI =0.65-1.11,P =0.23;RR =0.95,95%CI =0.78-1.17,P =0.51;HR =1.01,95%CI =0.90-1.13,P =0.87;HR =1.04,95%CI =0.91-1.20,P=0.56).Conclusion UCBT and MMUDT had emerged as an effective stem cell source to treatment hematological malignancies for patients lacked of HLA-matched related or unrelated donor.MMUDT had a certain advantage for the patients who had the greater risk of infection and lacked of HLA-matched donor compared with UCBT.

关 键 词：脐血干细胞移植 不全相合非血缘供者移植 血液肿瘤 META分析 

分 类 号：R617[医药卫生—外科学]