非血缘关系脐血干细胞移植治疗儿童急性白血病疗效的Meta分析

目的观察非血缘关系脐血移植（UCBT）和异体骨髓移植（UBMT）对儿童急性白血病的治疗效果。方法计算机检索Pubmed、Medline、The Cochrane controlled trial sregister、CNKI、CBM在2000年1月～2012年5月期间发表的关于儿童UCBT和UBMT对儿童急性白血病的疗效分析文献。从移植后白细胞植入情况、急慢性GVHD发生情况、复发情况、移植相关死亡率（TRM）、无病生存期（EFS）等方面对比分析UCBT和UBMT的临床疗效。采用ReviewManager4．2软件进行meta分析。结果检索出123篇文献，最终纳入5项研究，合计1104例儿童急性白血病患者。UCBT组和UBMT组比较，急慢性GVHD合并后的OR值分别为0．5395％CI（0．41—0．68），P〈0．05]和0．3595％CI（0．46—0．26），P〈0．05]，移植后的复发情况合并后的OR值为0．7195％CI（0．53—0．94），P=0．02]。结论UCBT治疗儿童急性白血病可减少移植后急、慢性GVHD发生率，减少移植后复发，UCBT是治疗儿童急性白血病病的有效方法。

Meta- Analysis of Unrelated Donor Umbilical Cord Blood Transplantation in Pediatric Patients with Acute Leukemia

Objective To compare the effects of UCBT versus UBMT in children with acute leukemi- a. Methods We systematically reviewed all data on comparative studies of UCBT versus UBMT in acute leukemia children requiring hematopoietic stem cell transplantation. The relevant studies were identified through a computerized literature search of the Pubmed, Medline, The Cochrane controlled trials register, CNKI and CBM （2001. 1 - 2012.5 ）. Meta analysis was statistically calculated with RevMan 4.2 soft- ware. The outcome of interest for our analysis was neutrophil engraftment, GVHD, relapse, transplanta- tion -related mortality （TRM） and five -year EFS. Results We obtained 123 records. Five trials tota- ling 1 104 patients had been assessed after data screening. Pooled comparisons of studies of UCBT and UBMT in children found that the incidence of chronic graft - versus - host disease （GVHD） was lower with UCBT OR=0.53; 95% CI （0.41 -0.68）, p 〈0.05], and the incidence of grades II-IV GVHD was also significantly different OR = 0.35 ; 95% CI （0.46 - 0.26）, p 〈 O. 05 ]. The incidence of relapse was also lower with UCBT OR =0.71; 95% CI （0.53 -0.94）, p =0.02]. Conclusion This study shows that UCBT is associated with less GVHD and relapse, UCBT can be considered as an al- ternative stem cell source for children.