Champlin R E, Schmitz N, Horowitz M M, Chapuis B, Chopra R, Cornelissen J J, Gale R P, Goldman J M, Loberiza F R, Hertenstein B, Klein J P, Montserrat E, Zhang M J, Ringdén O, Tomany S C, Rowlings P A, Van Hoef M E, Gratwohl A
International Bone Marrow Transplant Registry, Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
Blood. 2000 Jun 15;95(12):3702-9.
Peripheral blood cells are increasingly used in place of bone marrow as a source of hematopoietic stem cells for allogeneic transplantation. The relative efficacy of these 2 approaches is unknown. This retrospective multivariate analysis compared results of 288 HLA-identical sibling blood stem cell transplantations with results of 536 HLA-identical sibling bone marrow transplantations. No transplants were T-cell depleted. Median follow-up was 12 months, and analyses focused on 1-year outcomes. Recipients of blood stem cell transplants had more rapid recovery of neutrophils to at least 0.5 x 10(9)/L (median time to recovery, 14 days, compared with 19 days for marrow transplants; P <.001) and of platelets to at least 20 x 10(9)/L (median time, 18 days, compared with 25 days for marrow transplants; P <.001). There was no significant difference in the incidence of grades II to IV acute graft versus host disease (GVHD). The incidence of chronic GVHD was significantly higher after blood stem cell transplantation (1-year probability [95% confidence interval], 65% [56%-72%] compared with 53% [47%-59%]; P =.02) Relapse incidence in the 2 transplant groups did not differ significantly. Treatment-related mortality rates were lower and leukemia-free survival rates were higher with blood stem cell transplants in patients with advanced leukemia (acute leukemia in second remission or chronic myelogenous leukemia in accelerated phase) but not in early leukemia (acute leukemia in first remission or chronic myelogenous leukemia in chronic phase). The median time from transplantation to hospital discharge was 23 days after blood stem cell transplantation and 28 days after bone marrow transplantation (P =.003). Further study with longer follow-up is necessary to definitively establish the role of blood stem cells for allogeneic transplantation, especially in patients with good-risk disease. (Blood. 2000;95:3702-3709)
外周血细胞越来越多地被用作异基因移植中造血干细胞的来源，以替代骨髓。这两种方法的相对疗效尚不清楚。这项回顾性多变量分析比较了288例人类白细胞抗原（HLA）匹配的同胞血液干细胞移植结果与536例HLA匹配的同胞骨髓移植结果。所有移植均未进行T细胞去除。中位随访时间为12个月，分析重点为1年结局。血液干细胞移植受者的中性粒细胞恢复至至少0.5×10⁹/L的速度更快（恢复的中位时间为14天，而骨髓移植为19天；P<0.001），血小板恢复至至少20×10⁹/L的速度也更快（中位时间为18天，而骨髓移植为25天；P<0.001）。Ⅱ至Ⅳ级急性移植物抗宿主病（GVHD）的发生率无显著差异。血液干细胞移植后慢性GVHD的发生率显著更高（1年概率[95%置信区间]，65%[56%-72%]，而骨髓移植为53%[47%-59%]；P=0.02）。两个移植组的复发率无显著差异。在晚期白血病（第二次缓解期的急性白血病或加速期的慢性粒细胞白血病）患者中，血液干细胞移植的治疗相关死亡率较低，无白血病生存率较高，但在早期白血病（第一次缓解期的急性白血病或慢性期的慢性粒细胞白血病）患者中并非如此。血液干细胞移植后从移植到出院的中位时间为23天，骨髓移植后为28天（P=0.003）。有必要进行更长时间随访的进一步研究，以明确确定血液干细胞在异基因移植中的作用，尤其是在低风险疾病患者中。（《血液》。2000年；95:3702 - 3709）
