Mohty Mohamad, Kuentz Mathieu, Michallet Mauricette, Bourhis Jean-Henri, Milpied Noël, Sutton Laurent, Jouet Jean-Pierre, Attal Michel, Bordigoni Pierre, Cahn Jean-Yves, Boiron Jean-Michel, Blaise Didier
Transplantation and Cellular Therapy Unit, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 132273 Marseille Cedex 09, France.
Blood. 2002 Nov 1;100(9):3128-34. doi: 10.1182/blood.V100.9.3128.
The use of peripheral blood stem cells (PBSCs) is rapidly growing in the allogeneic transplantation setting as an alternative to bone marrow (BM). We previously reported a higher incidence of chronic graft-versus-host disease (cGVHD) associated with allogeneic PBSC transplantation in a randomized trial. In this follow-up report, we analyzed the evolution of cGVHD in the patients (n = 101) enrolled on this study. At a median follow-up of 45 months (range, 31-57 months), we found that the 3-year cumulative incidence of cGVHD was 65% (95% confidence interval [CI] 51%-78%) in the PBSC group and 36% (95% CI 23%-49%) in the BM group (P =.004). We also found that extensive cGVHD was more frequent in the PBSC group (44% [95% CI 30%-58%] vs 17% [95% CI 7%-27%]; P =.004). The prevalence of cGVHD was always higher in the PBSC arm. Ocular involvement was more frequent in PBSC recipients (P =.02). Cutaneous and liver involvement was similar among BM and PBSC recipients. Chronic GVHD required multiple courses of immunosuppressive therapy in addition to cyclosporine and corticosteroids during longer periods (P =.03). Altogether, this translated into longer periods of hospitalization after transplantation in the PBSC group (P =.04). Finally, we also confirm that cGVHD after PBSC transplantation is associated with an antileukemic effect that is at least as potent as after BM. However, to date, this has not translated into a survival difference, possibly due to the early-stage leukemic status of these patients or to the relatively small size of the study population.
在异基因移植中，外周血干细胞（PBSC）作为骨髓（BM）的替代物，其应用正在迅速增加。我们先前在一项随机试验中报告了与异基因PBSC移植相关的慢性移植物抗宿主病（cGVHD）的较高发生率。在这份随访报告中，我们分析了参与本研究的患者（n = 101）中cGVHD的演变情况。在中位随访45个月（范围31 - 57个月）时，我们发现PBSC组中cGVHD的3年累积发生率为65%（95%置信区间[CI] 51% - 78%），而BM组为36%（95% CI 23% - 49%）（P = 0.004）。我们还发现广泛性cGVHD在PBSC组中更常见（44% [95% CI 30% - 58%] 对17% [95% CI 7% - 27%]；P = 0.004）。cGVHD的患病率在PBSC组中始终较高。眼部受累在PBSC受者中更常见（P = 0.02）。皮肤和肝脏受累在BM和PBSC受者中相似。慢性GVHD除了在较长时间内使用环孢素和皮质类固醇外，还需要多个疗程的免疫抑制治疗（P = 0.03）。总体而言，这导致PBSC组移植后住院时间更长（P = 0.04）。最后，我们还证实PBSC移植后的cGVHD与抗白血病效应相关，其效力至少与BM移植后相同。然而，迄今为止，这尚未转化为生存差异，可能是由于这些患者的白血病处于早期阶段或研究人群规模相对较小。
