Lickliter J D, McGlave P B, DeFor T E, Miller J S, Ramsay N K, Verfaillie C M, Burns L J, Wagner J E, Eastlund T, Dusenbery K, Weisdorf D J
Blood and Marrow Transplant Program, University of Minnesota, Minneapolis, Minnesota, USA.
Bone Marrow Transplant. 2000 Oct;26(7):723-8. doi: 10.1038/sj.bmt.1702606.
We performed a case-control analysis of 42 patients with advanced leukemia or MDS comparing peripheral blood stem cell (PBSC) with marrow grafts (BMT) from HLA-matched sibling donors. PBSC were mobilized with G-CSF (7.5 microg/kg/day) and yielded a median of 6.7 x 10(6) CD34+ cells/kg (range, 1.6-15.0) and 2.7 x 10(8) CD3+ cells/kg (range, 1.1-7.1) vs marrow grafts with a median of 2.0 x 10(8) nucleated cells/kg (range, 1.8-2.2). Recovery was significantly faster after PBSCT compared to BMT, with a median of 17 (range, 12-26) vs 26 (range, 16-36) days, respectively, to neutrophils >0.5 x 10(9)/l (P < 0.01), and 22 (range, 12->60) vs 42 (range, 18->60) days, for platelet recovery (P < 0.01). Transplantation of >/=7 x 10(6) CD34+ cells/kg accelerated recovery to >20 x 10(9) l platelets; median 17 days (range, 12-19) vs 23 days (range, 17-36) for those receiving <7 x 10(6)/kg (P = 0.01). PBSC and marrow recipients had similar risks of grades II-IV or III-IV acute GVHD or extensive chronic GVHD (all P > 0.3). At 1 year after PBSCT and BMT, the risk of relapse was 41% and 32%, respectively (P = 0.47), and the probability of survival was 46% and 48%, respectively (P = 0.70). HLA-matched sibling PBSCT resulted in faster neutrophil and platelet engraftment compared to BMT, with no subsequent differences in acute or chronic GVHD, relapse or survival. A minimum of 7 x 10(6) CD34+ cells/kg in PBSC grafts may be required for very rapid platelet engraftment. Bone Marrow Transplantation (2000) 26, 723-728.
我们对42例晚期白血病或骨髓增生异常综合征患者进行了病例对照分析，比较了来自人类白细胞抗原（HLA）匹配同胞供者的外周血干细胞（PBSC）移植与骨髓移植（BMT）。PBSC通过粒细胞集落刺激因子（G-CSF，7.5微克/千克/天）动员，中位收获量为6.7×10⁶个CD34⁺细胞/千克（范围1.6 - 15.0）和2.7×10⁸个CD3⁺细胞/千克（范围1.1 - 7.1），而骨髓移植的中位收获量为2.0×10⁸个有核细胞/千克（范围1.8 - 2.2）。与BMT相比，PBSCT后的恢复明显更快，中性粒细胞>0.5×10⁹/升的中位时间分别为17天（范围12 - 26）和26天（范围16 - 36）（P<0.01），血小板恢复的中位时间分别为22天（范围12 ->60）和42天（范围18 ->60）（P<0.01）。移植≥7×10⁶个CD34⁺细胞/千克可加速血小板恢复至>20×10⁹/升；接受<7×10⁶/千克的患者中位时间为23天（范围17 - 36），而接受≥7×10⁶个CD34⁺细胞/千克的患者中位时间为17天（范围12 - 19）（P = 0.01）。PBSC和骨髓接受者发生II - IV级或III - IV级急性移植物抗宿主病（GVHD）或广泛慢性GVHD的风险相似（所有P>0.3）。在PBSCT和BMT后1年，复发风险分别为41%和32%（P = 0.47），生存概率分别为46%和48%（P = 0.70）。与BMT相比，HLA匹配同胞PBSCT导致中性粒细胞和血小板植入更快，急性或慢性GVHD、复发或生存方面随后无差异。PBSC移植物中至少需要7×10⁶个CD34⁺细胞/千克才能实现非常快速的血小板植入。《骨髓移植》（2000年）26卷，723 - 728页
