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ORIGINAL ARTICLE
Year : 2018  |  Volume : 131  |  Issue : 18  |  Page : 2185-2192

Relationship of Cell Compositions in Allografts with Outcomes after Haploidentical Transplantation for Acquired Severe Aplastic Anemia: Effects of CD34+ and CD14+ Cell Doses


1 Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044, China
2 Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044; Peking-Tsinghua Center for Life Sciences, Beijing 100871, China
3 Peking University Institute of Hematology, Peking University People's Hospital, Beijing 100044; Collaborative Innovation Center of Hematology, Peking University, Beijing 100871, China

Correspondence Address:
Prof. Ying-Jun Chang
Peking University Institute of Hematology, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing 100044
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0366-6999.240810

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Background: The dose of certain cell types in allografts affects engraftment kinetics and clinical outcomes after allogeneic stem cell transplantation (SCT). Hence, the present study investigated the association of cell compositions in allografts with outcomes after unmanipulated haploidentical SCT (haplo-SCT) for patients with acquired severe aplastic anemia (SAA). Methods: A total of 131 patients with SAA who underwent haplo-SCT were retrospectively enrolled. Cell subsets in allografts were determined using flow cytometry. To analyze the association of cellular compositions and outcomes, Mann–Whitney U nonparametric tests were conducted for patient age, sex, weight, human leukocyte antigen mismatched loci, ABO-matched status, patient ABO blood type, donor-recipient sex match, donor-recipient relationship, and each graft component. Multivariate analysis was performed using logistic regression to determine independent influence factors involving dichotomous variables selected from the univariate analysis. Results: A total of 126 patients (97.7%) achieved neutrophil engraftment, and 121 patients (95.7%) achieved platelet engraftment. At 100 days after transplantation, the cumulative incidence of II–IV acute graft-versus-host disease (GVHD) was 32.6%. After a median follow-up of 842 (range: 124–4110) days for surviving patients, the cumulative incidence of total chronic GVHD at 3 years after transplantation was 33.7%. The probability of overall survival at 3 years was 83.0%. Multivariate analysis showed that higher total doses of CD14+ (P = 0.018) and CD34+ cells (P < 0.001) were associated with a successful platelet engraftment. A successful platelet was associated with superior survival (P < 0.001). No correlation of other cell components with outcomes was observed. Conclusions: These results provide evidence and explain that higher doses of CD34+ and CD14+ cells in haploidentical allografts positively affect platelet engraftment, contributing to superior survival for patients with SAA.

 

 Abstract in Chinese

接受单倍型造血干细胞移植的重型再生障碍性贫血患者回输的CD34+CD14+细胞的数量与移植预后的关系

摘要
背景:在异基因造血干细胞移植(allogeneic stem cell transplantation,allo-SCT)中,回输的特定移植物组分的数量影响患者造血重建和移植预后。因此,我们研究了在接受单倍型造血干细胞移植(haploidentical stem cell transplantation,Haplo-SCT)的重型再生障碍性贫血(severe aplastic anemia,SAA)患者中,回输的各种移植物组分与移植预后的关系。

方法:我们的研究回顾性分析了131例接受Haplo-SCT的SAA患者,利用流式细胞术检测患者回输的移植物中各细胞亚群,利用非参数检验分析患者年龄、患者性别、供受者HLA不合位点、供受者ABO血型相合情况、患者ABO血型、供受者性别关系、供受者关系以及各移植物组分数量和移植预后的关系,利用logistic回归分析进行多因素分析。

结果:在131例患者中,126例(97.7%)患者获得粒细胞植入,121例(95.7%)患者获得血小板植入。患者移植后100天的II-IV度急性移植物抗宿主病(graft-versus-host disease,GVHD)累积发生率为32.6%。所有存活患者的中位随访时间为842(124-4110)天,三年的慢性GVHD累积发生率为33.7%,3年总生存率(overall survival,OS)为83.0%。多因素分析显示,回输高剂量CD14+细胞(P=0.018)和CD34+细胞(P<0.001)的患者有更好的血小板植入率;而血小板植入的患者有更好的OS(P<0.001)。我们的分析结果没有发现其他移植物组分与预后相关。

结论:我们的研究结果表明,在接受Haplo-SCT的SAA患者中,回输高剂量的CD34+和CD14+细胞促进血小板植入,进而改善患者的总体生存。



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