异基因相关骨髓移植与外周血干细胞移植治疗慢性髓性白血病的随机试验

Randomized trial of allogeneic related bone marrow transplantation versus peripheral blood stem cell transplantation for chronic myeloid leukemia.

作者信息

Oehler Vivian G, Radich Jerald P, Storer Barry, Blume Karl G, Chauncey Thomas, Clift Reginald, Snyder David S, Forman Stephen J, Flowers Mary E D, Martin Paul, Guthrie Katherine A, Negrin Robert S, Appelbaum Frederick R, Bensinger William

机构信息

Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

出版信息

Biol Blood Marrow Transplant. 2005 Feb;11(2):85-92. doi: 10.1016/j.bbmt.2004.09.010.

Abstract

Seventy-two chronic myeloid leukemia patients were enrolled as part of a larger randomized trial at 3 centers between March 1996 and July 2001 to undergo either HLA-matched related allogeneic bone marrow (BM) or filgrastim (granulocyte colony-stimulating factor)-mobilized peripheral blood stem cell (PBSC) transplantation. Forty patients received BM, and 32 patients received PBSCs. There was no statistically significant difference in the incidence of acute or chronic graft-versus-host disease (GVHD), overall survival, disease-free survival, or non-relapse-related mortality between patients receiving BM or PBSC transplants. The cumulative incidence of grade II to IV acute GVHD was 49% in BM and 55% in PBSC recipients ( P = .48). The cumulative incidence of clinical extensive chronic GVHD was 50% in BM and 59% in PBSC recipients ( P = .46). Among 62 chronic phase chronic myeloid leukemia patients, there was no significant difference in overall survival (87% versus 81%; P = .59), disease-free survival (80% versus 81%; P = .61), or non-relapse-related mortality (13% versus 19%; P = .60) by cell source (BM versus PBSCs). Among chronic phase patients, however, there was a trend toward a higher cumulative incidence of relapse at 3 years in BM recipients (7% versus 0%; P = .10) and a higher cumulative incidence of chronic GVHD in PBSC recipients (59% versus 40%; P = .11). The trend toward a higher relapse incidence in BM recipients persisted with a longer follow-up.

摘要

1996年3月至2001年7月期间,作为一项更大规模随机试验的一部分,72例慢性髓性白血病患者在3个中心入组,接受人类白细胞抗原(HLA)匹配的相关异基因骨髓(BM)或非格司亭(粒细胞集落刺激因子)动员的外周血干细胞(PBSC)移植。40例患者接受了BM移植,32例患者接受了PBSC移植。接受BM或PBSC移植的患者在急性或慢性移植物抗宿主病(GVHD)的发生率、总生存期、无病生存期或非复发相关死亡率方面无统计学显著差异。接受BM移植的患者中II至IV级急性GVHD的累积发生率为49%,接受PBSC移植的患者为55%(P = 0.48)。临床广泛慢性GVHD的累积发生率在接受BM移植的患者中为50%,在接受PBSC移植的患者中为59%(P = 0.46)。在62例慢性期慢性髓性白血病患者中,按细胞来源(BM与PBSC)比较,总生存期(87%对81%;P = 0.59)、无病生存期(80%对81%;P = 0.61)或非复发相关死亡率(13%对19%;P = 0.60)无显著差异。然而,在慢性期患者中,BM接受者在3年时复发的累积发生率有升高趋势(7%对0%;P = 0.10),PBSC接受者慢性GVHD的累积发生率更高(59%对40%;P = 0.11)。随着随访时间延长,BM接受者复发发生率较高的趋势持续存在。

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