Wannesson L, Panzarella T, Mikhael J, Keating A
Department of Medical Oncology and Hematology, Princess Margaret Hospital, University Health Network, University of Toronto, 610 University Avenue, Toronto, Ontario, Canada.
Ann Oncol. 2007 Apr;18(4):623-32. doi: 10.1093/annonc/mdm069. Epub 2007 Mar 12.
The objective of this systematic review is to examine the feasibility and safety of autologous noncryopreserved stem-cell transplants. This technique avoids the cost of establishing and maintaining a cryopreservation facility and may be of value for transplant centers in regions with limited economic resources. The primary outcome was the graft failure rate. In addition, a detailed description of the high-dose therapy regimens employed was undertaken. Secondary outcomes were transplant-related mortality and neutrophil and platelet engraftments times. Sixteen well-conducted nonrandomized studies met the eligibility criteria. Only two cases of graft failure (0.36%) occurred among 560 assessable patients receiving high-dose therapy and autotransplant for non-Hodgkin's lymphoma, Hodgkin's lymphoma, multiple myeloma, germ-cell tumors and acute leukemias. The most traditional high-dose schedules were used, although often modified to shorter regimens. High-dose melphalan appeared especially useful given its short half-life and was used to treat multiple myeloma by most groups. Secondary outcomes were comparable to those reported in the most relevant studies addressing standard (cryopreserved) autotransplant. According to this study, the use of autologous noncryopreserved hematopoietic progenitors to support patients undergoing high-dose therapy is feasible and safe.
本系统评价的目的是检验自体非冷冻保存干细胞移植的可行性和安全性。该技术避免了建立和维护冷冻保存设施的成本，对于经济资源有限地区的移植中心可能具有价值。主要结局是移植失败率。此外，还对所采用的高剂量治疗方案进行了详细描述。次要结局是移植相关死亡率以及中性粒细胞和血小板植入时间。16项实施良好的非随机研究符合纳入标准。在560例接受高剂量治疗和自体移植治疗非霍奇金淋巴瘤、霍奇金淋巴瘤、多发性骨髓瘤、生殖细胞肿瘤和急性白血病的可评估患者中，仅发生了2例移植失败（0.36%）。使用了最传统的高剂量方案，不过通常会调整为更短的疗程。鉴于美法仑半衰期短，高剂量美法仑显得特别有用，大多数研究组都用其治疗多发性骨髓瘤。次要结局与针对标准（冷冻保存）自体移植的最相关研究所报告的结局相当。根据本研究，使用自体非冷冻保存造血祖细胞支持接受高剂量治疗的患者是可行且安全的。
