对于来自 HLA 同型同胞供者的异基因移植，动员外周血作为造血干细胞来源与骨髓相比是否具有可比性？一项病例对照研究。
Is mobilized peripheral blood comparable with bone marrow as a source of hematopoietic stem cells for allogeneic transplantation from HLA-identical sibling donors? A case-control study.
作者信息
Gallardo David, de la Cámara Rafael, Nieto Jose B, Espigado Ildefonso, Iriondo Arturo, Jiménez-Velasco Antonio, Vallejo Carlos, Martín Carmen, Caballero Dolores, Brunet Salut, Serrano David, Solano Carlos, Ribera Josep M, de la Rubia Javier, Carreras Enric
机构信息
Clinical Haematology Department, Institut Català d'Oncologia, Hospital Josep Trueta, Avda. França s/n, Girona, Spain.
出版信息
Haematologica. 2009 Sep;94(9):1282-8. doi: 10.3324/haematol.2009.006924.
BACKGROUND
Granulocyte colony-stimulating factor mobilized peripheral blood stem cells are increasingly used instead of bone marrow as a stem cell source for transplantation. Whereas this change is almost complete for autologous transplantation, there are some concerns when considering allogeneic transplants.
DESIGN AND METHODS
We performed a retrospective case-control study including 820 adult patients who had received an allogeneic stem cell transplant from an HLA-identical sibling donor. Quality of life (QoL) was assessed in 150 patients using the EORTC Quality of Life Questionnaire C30 (QLQ-C30).
RESULTS
There were no statistically significant differences in overall survival at ten years (bone marrow: 48.9% vs. peripheral blood stem cells: 39.8%; p=0.621), transplant-related mortality (bone marrow: 28.9% vs. peripheral blood stem cells: 34.4%; p=0.682) or relapse incidence at 9 years (29.4% vs. 35.2%, respectively; p=0.688). Similar outcomes were maintained independently of the phase of the disease. However, multivariate analysis identified a higher incidence of acute graft-versus-host disease grades II-IV (p: 0.023; Hazard ratio [HR]: 1.41; 95% confidence interval [CI]: 1.05-1.89) and grades III-IV (p: 0.006; HR: 1.89; 95% CI: 1.20-2.98), in the peripheral blood stem cells-stem cell transplant group. As previously described, extensive chronic graft-versus-host disease was also more frequent in the peripheral blood stem cells group (28% vs. 15.6%; p<0.001). Patients transplanted with peripheral blood stem cells had significant impairment of role and social functioning.
CONCLUSIONS
Although overall survival was not affected by the stem cell source, peripheral blood stem cell transplants were associated with a higher risk of both acute and chronic GvHD. Global quality of life was similar in both groups, but patients transplanted with peripheral blood stem cells showed worse role and social functioning scores, probably related to the increased incidence of chronic graft-versus-host disease.
背景
粒细胞集落刺激因子动员的外周血干细胞越来越多地被用作移植的干细胞来源，以替代骨髓。在自体移植中这种转变几乎已经完成，但在考虑同种异体移植时仍存在一些担忧。
设计与方法
我们进行了一项回顾性病例对照研究，纳入了820例接受来自HLA相同同胞供体的同种异体干细胞移植的成年患者。使用欧洲癌症研究与治疗组织生活质量问卷C30（QLQ-C30）对150例患者的生活质量进行了评估。
结果
十年总生存率（骨髓：48.9% 对比外周血干细胞：39.8%；p = 0.621）、移植相关死亡率（骨髓：28.9% 对比外周血干细胞：34.4%；p = 0.682）或9年复发率（分别为29.4% 对比35.2%；p = 0.688）均无统计学显著差异。无论疾病处于何阶段，均保持相似的结果。然而，多因素分析显示外周血干细胞移植组中急性移植物抗宿主病II-IV级（p：0.023；风险比[HR]：1.41；95%置信区间[CI]：1.05 - 1.89）和III-IV级（p：0.006；HR：1.89；95% CI：1.20 - 2.98）的发生率更高。如前所述，外周血干细胞组广泛慢性移植物抗宿主病也更常见（28% 对比15.6%；p < 0.001）。接受外周血干细胞移植的患者在角色和社会功能方面有显著损害。
结论
虽然总生存率不受干细胞来源的影响，但外周血干细胞移植与急性和慢性移植物抗宿主病的较高风险相关。两组的总体生活质量相似，但接受外周血干细胞移植的患者角色和社会功能得分较差，这可能与慢性移植物抗宿主病发生率增加有关。
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