单中心异基因外周血干细胞与骨髓移植结果的回顾性比较：聚焦移植物抗宿主病和复发的发生率
A retrospective comparison of allogeneic peripheral blood stem cell and bone marrow transplantation results from a single center: a focus on the incidence of graft-vs.-host disease and relapse.
作者信息
Ustün C, Arslan O, Beksaç M, Koç H, Gürman G, Ozçelik T, Yilmaz B, Ilhan O, Akan H, Ozcan M, Demirer T, Uysal A, Konuk N, Arat M, Dilek I, Celebi H, Coskun H S
机构信息
Department of Hematology-Oncology and Bone Marrow Transplantation, Ibni Sina Hospital, Medical School of Ankara, Ankara University, Turkey.
出版信息
Biol Blood Marrow Transplant. 1999;5(1):28-35. doi: 10.1053/bbmt.1999.v5.pm10232738.
To detect the effect of the stem cell source, allogeneic peripheral blood stem cell transplantations (alloPBSCTs) performed between 1995 and 1997 from human leukocyte antigen (HLA)-identical siblings in 40 patients with acute and chronic hematological disorders were compared with a historical group of 40 patients with similar variables who had received allogeneic bone marrow transplants (alloBMTs) between 1993 and 1995. Patients in both groups were identical except that both the recipient and the donor ages were, on average, higher in the alloPBSCT group (26 vs. 36 [p = 0.005] and 27 vs. 32 [p = 0.024], respectively). Patients received similar therapy excluding posttransplant granulocyte colony-stimulating factor administration (97% in alloBMT vs. 12.5% in alloPBSCT). The median time to reach neutrophil counts >0.5 x 10(9)/L and platelet counts >20 x 10(9)/L was 13 and 14 days, respectively, in patients receiving alloPBSCTs compared with 19 and 27 days in patients receiving alloBMTs (p = 0.0014 and p = 0.0002). The alloPBSCT group required similar transfusions of red blood cells or platelets. The incidence of grade II-IV acute graft-vs.-host disease (aGVHD) was similar in both groups. However, chronic GVHD (cGVHD) of all grades developed in 78.1% of patients in the alloPBSCT group after a median follow-up period of 12.5 (range 0.5-34) months. In alloBMT recipients, cGVHD of all grades developed in 21.4% after a median follow-up period of 38 (range 0.5-62) months (p = 0.00001). Day 100 transplant-related mortality was also similar: 20% (8 of 40) in the alloBMT patients and 17.5% (7 of 40) in the alloPBSCT group. Although not statistically significant, a relatively higher relapse rate occurred in the alloBMT group (21.4 vs. 10.7%). The estimated disease-free survival in month 24 was 51.3% for alloBMT and 54.6% for alloPBSCT, and the estimated overall survival in month 24 was 56.1% for alloBMT and 64.6% for alloPBSCT. In conclusion, this retrospective comparison suggests that alloPBSCT from HLA-identical donors is associated with faster engraftment, fewer transfusions, and no greater incidence of aGVHD, but a high incidence of cGVHD.
为检测干细胞来源的影响，将1995年至1997年间40例患有急性和慢性血液系统疾病的患者接受来自人类白细胞抗原（HLA）相合同胞的异基因外周血干细胞移植（alloPBSCT）的情况，与1993年至1995年间40例接受异基因骨髓移植（alloBMT）且具有相似变量的历史对照组患者进行比较。两组患者除了alloPBSCT组受者和供者的年龄平均更高外（分别为26岁对36岁[p = 0.005]和27岁对32岁[p = 0.024]），其他方面均相同。患者接受了相似的治疗，但移植后粒细胞集落刺激因子的使用情况不同（alloBMT组为97%，alloPBSCT组为12.5%）。接受alloPBSCT的患者中性粒细胞计数>0.5×10⁹/L和血小板计数>20×10⁹/L的中位时间分别为13天和14天，而接受alloBMT的患者分别为19天和27天（p = 0.0014和p = 0.0002）。alloPBSCT组所需的红细胞或血小板输注量相似。两组中II-IV级急性移植物抗宿主病（aGVHD）的发生率相似。然而，alloPBSCT组在中位随访12.5（范围0.5 - 34）个月后，78.1%的患者发生了所有级别的慢性移植物抗宿主病（cGVHD）。在alloBMT受者中，中位随访38（范围0.5 - 62）个月后，21.4%的患者发生了所有级别的cGVHD（p = 0.00001）。移植后100天的相关死亡率也相似：alloBMT患者为20%（40例中的8例），alloPBSCT组为17.5%（40例中的7例）。虽然无统计学意义，但alloBMT组的复发率相对较高（21.4%对10.7%）。alloBMT组24个月时的无病生存率估计为51.3%，alloPBSCT组为54.6%；alloBMT组24个月时的总生存率估计为56.1%，alloPBSCT组为64.6%。总之，这项回顾性比较表明，来自HLA相合同胞供者的alloPBSCT与更快的植入、更少的输血以及aGVHD发生率不高相关，但cGVHD发生率较高。
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