Anthony Nolan Trust, London Royal Marsden Hospital, London Imperial College, London, UK.
Br J Haematol. 2011 Apr;153(2):244-52. doi: 10.1111/j.1365-2141.2011.08615.x. Epub 2011 Mar 8.
There is little information published comparing peripheral blood stem cells (PBSC) with bone marrow (BM) as the stem cell source in the long-term outcome in recipients of T-cell depleted (TCD) unrelated donor (UD) transplants. We present retrospective outcome data on 306 recipients of myeloablative, human leucocyte antigen-matched UD allografts using pre-transplant in-vivo Alemtuzumab. Transplants were performed between 2000 and 2007 for chronic myeloid leukaemia in first chronic phase and acute leukaemia in first or second complete remission; 184 patients received BM and 122 PBSC. The median age was 28·9 years (<1-58) and the median follow-up was 48 months. Overall survival at 8 years was 53%. The incidence of acute graft-versus-host disease (GvHD) was significantly higher in PBSC (65%) than BM recipients (49%; P=0·012). This represented only grade 1 GvHD with no difference in grade II-IV aGvHD (BM 23% PBSC 24%). The incidence of chronic GvHD, either overall (BM 47%, PBSC 49%) or extensive (BM 15%, PBSC 13%) was not increased with PBSC. The incidence of relapse, non-relapse mortality and survival were not significantly different. Whilst accepting the limitations of retrospective analyses, we suggest the increased risk of GvHD in recipients of PBSC in T-replete transplants is offset by in-vivo Alemtuzumab, and that either stem cell source can be used with good outcomes in this setting.
关于 T 细胞耗竭(TCD)无关供者(UD)移植受者中,外周血干细胞(PBSC)与骨髓(BM)作为干细胞来源的长期结果,发表的信息很少。我们报告了 306 例接受同种异体骨髓移植、人白细胞抗原匹配、移植前体内使用阿仑单抗预处理的受者的回顾性结果数据。这些患者在 2000 年至 2007 年间接受了治疗,用于慢性髓系白血病的首次慢性期和急性白血病的首次或第二次完全缓解;184 例患者接受 BM,122 例患者接受 PBSC。中位年龄为 28.9 岁(1-58 岁),中位随访时间为 48 个月。8 年总生存率为 53%。PBSC 组(65%)急性移植物抗宿主病(GvHD)的发生率明显高于 BM 组(49%;P=0.012)。这仅代表 1 级 GvHD,2-4 级 aGvHD(BM 组 23%,PBSC 组 24%)无差异。慢性 GvHD 的发生率,无论是总体(BM 组 47%,PBSC 组 49%)还是广泛(BM 组 15%,PBSC 组 13%),均未因 PBSC 而增加。复发、非复发死亡率和生存率无显著差异。尽管我们接受回顾性分析的局限性,但我们认为,在 T 细胞充足的移植中,PBSC 受者 GvHD 风险增加被体内阿仑单抗所抵消,在这种情况下,任何干细胞来源都可以获得良好的结果。
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