Siddiq Samreen, Pamphilon Derwood, Brunskill Susan, Doree Carolyn, Hyde Chris, Stanworth Simon
Bristol Haematology Oncology Centre , United Bristol Healthcare Trust, Horfield Road , Bristol, UK, BS2 8ED.
Cochrane Database Syst Rev. 2009 Jan 21(1):CD006406. doi: 10.1002/14651858.CD006406.pub2.
Haemopoietic stem cells can be collected from a donor either as a bone marrow harvest or by peripheral blood collection. Both techniques have risks for the donor.
The aim of this review was to identify the adverse effects of haemopoietic stem cell donation and to compare the tolerability and safety of the two methods.
We searched bibliographic databases including the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE and EMBASE up to May 2008. We also searched reference lists of articles and contacted experts in the field.
Randomised controlled trials enrolling haemopoietic stem cell donors and evaluating the different methods of donating haemopoietic stem cells were eligible.
Two authors independently screened studies for inclusion. We extracted data and evaluated methodological quality. Quantitative analysis was not possible for most outcomes, but where used we preferred random-effects models due to the variability between the included studies.
Six trials (807 donors) were eligible: all were substudies, or constituent parts of, larger randomised controlled trials of bone marrow and peripheral blood stem cell allogeneic transplantation. No included trial was designed solely to measure and assess the experience of stem cell donors. The donors in all studies were related to the stem cell recipient. Overall, both types of donors experienced pain subsequent to donation, and psychological morbidity. The trend was for bone marrow donors to experience more pain at the donation site, more overall adverse events, and more days of restricted activity. They were also more likely to require hospitalisation than peripheral blood stem cell donors. In contrast, peripheral blood stem cell donors experienced more pain prior to donation, which may be related to the pre-donation administration of granulocyte colony stimulating factor (G-CSF). The methodological quality of the studies was poor and indicated limitations due to the risk of selection and attrition bias. The proportion of donors from the parent trial not included in the donor substudies was also inadequately explained.
AUTHORS' CONCLUSIONS: The different short-term morbidities associated with each type of haemopoietic stem cell donation were clear, with bone marrow donors experiencing more pain and more restriction post-donation than peripheral blood donors. However, the studies were limited by their methodological quality, failure to provide long-term follow up (for which larger numbers of donors would be required) and a failure to apply consistent measures of quality of life in a way which allows more meaningful evaluation across studies.
造血干细胞可以从供体处采集，方式有骨髓采集或外周血采集。两种技术对供体都有风险。
本综述的目的是确定造血干细胞捐赠的不良反应，并比较两种方法的耐受性和安全性。
我们检索了文献数据库，包括Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2008年第2期）、MEDLINE和EMBASE，检索截至2008年5月。我们还检索了文章的参考文献列表并联系了该领域的专家。
纳入造血干细胞供体并评估不同造血干细胞捐赠方法的随机对照试验符合要求。
两位作者独立筛选纳入研究。我们提取数据并评估方法学质量。大多数结局无法进行定量分析，但在可行时，由于纳入研究之间存在变异性，我们优先选择随机效应模型。
六项试验（807名供体）符合要求：所有试验均为更大规模的骨髓和外周血干细胞同种异体移植随机对照试验的子研究或组成部分。没有纳入的试验是专门设计用于测量和评估干细胞供体的体验的。所有研究中的供体均与干细胞接受者有亲缘关系。总体而言，两种类型的供体在捐赠后都会经历疼痛以及心理问题。趋势是骨髓供体在捐赠部位经历更多疼痛、更多总体不良事件以及更多天的活动受限。他们也比外周血干细胞供体更有可能需要住院治疗。相比之下，外周血干细胞供体在捐赠前经历更多疼痛，这可能与捐赠前使用粒细胞集落刺激因子（G-CSF）有关。研究的方法学质量较差，由于存在选择和损耗偏倚的风险而存在局限性。母试验中未纳入供体子研究的供体比例也未得到充分解释。
每种造血干细胞捐赠相关的不同短期发病率很明显，骨髓供体在捐赠后比外周血供体经历更多疼痛和更多限制。然而，这些研究受到方法学质量的限制，未能提供长期随访（这需要更多数量的供体），并且未能以一种允许在不同研究间进行更有意义评估的方式应用一致的生活质量测量方法。
