137例单份非亲缘脐血造血干细胞移植患者的临床研究

Clinical study on 137 cases of unrelated single unit umbilical cord blood hematopoietic stem cell transplantation

目的 分析单份非亲缘脐血造血干细胞移植（sUCBT）的预后影响因素及脐血深低温冻存时间长短与细胞活力、移植预后的相关性.方法 回顾性研究2007年3月15日至2013年12月26日使用上海脐血库提供的脐血进行sUCBT的来自28家医院的137例患者,脐血平均冻存时间为698（96～1 968）d,复苏后细胞活力平均为87.4％.结果 脐血冻存2年以下及2年以上两组患者,细胞活力及患者的造血重建天数、植入失败率、急性移植物抗宿主病（GVHD）发生率及总体生存（OS）率差异均无统计学意义,两组5年OS率分别为55.6％和67.9％ （P=0.124）.2011年以后移植的患者OS率显著高于2011年及以前移植的患者（79.6％对48.7％,P=0.001）.多因素分析中,年龄＞16岁（RR=2.830,P=0.027）及2011年及以前移植（RR=0.203,P＜0.001）是治疗相关死亡的危险因素.结论 近两年sUCBT预后明显改善,脐血复苏后细胞活力、移植临床预后与脐血冻存时间长短无关.

Objective To evaluate relevant prognostic factors of unrelated single unit umbilical cord blood hematopoietic stem cell transplantation （sUCBT）,and to explore the correlation between cryopreservation time of cord blood and cell viability and outcome of sUCBT.Methods Retrospective analysis of 137 patients undergoing sUCBT with cord blood provided by Shanghai Cord Blood Bank from Mar.15,2007 to Dec.26,2013 were performed in this study.The mean cryopreservation time of 137 units cord blood was 698 （96-1968） days,with mean cell viability of 87.4% after thawing.Results No statistical difference on cell viability,hematopoietic reconstitution,graft failure,acute graft versus host disease （GVHD） and overall survival （OS） was found between patients transfused with cord blood preserved below and above 2 years.The 5-year OS of patients transfused with cord blood preserved below and above 2 years were 55.6% and 67.9%,respectively （P=0.124）.OS of the UCBT at 2011 and before,and after 2011 was 48.7% and 79.6%,respectively （P=0.001）.Age above 16-year-old （RR=2.830,P=0.027） and UCBT at 2011 and before （RR=0.203,P〈0.001） were two risk factors of treatment related mortality.Conclusion Outcome of sUCBT in China had significant improvement in recent 2 years.Cryopreservation time of cord blood had no statistical correlation to cell viability after thawing and clinical outcome.