Department of Hematology, Third Affiliated Hospital of Hebei Medical University, Shijiazhuang, China.
Ann Hematol. 2012 Mar;91(3):427-37. doi: 10.1007/s00277-011-1299-8. Epub 2011 Jul 26.
Controversy remains regarding the transplant outcomes of human leukocyte antigen-identical related bone marrow transplantation (BMT) and peripheral blood stem cell transplantation (PBSCT) for the treatment of patients with hematological malignancies. To provide an estimate of the effect of BMT and PBSCT on clinical outcomes in patients with hematological malignancies, we conducted a meta-analysis based on time-to-event data from 17 randomized controlled trials. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL), from 1972 through July 2010, and conference proceedings through July 2009 and reference lists, without any language restriction, of randomized trials that compared the transplant outcomes after BMT and PBSCT in patients with hematological malignancies were searched for details. Two independent reviewers extracted the data. The outcomes examined were engraftment, graft-versus-host disease (GVHD), relapse, transplant-related mortality (TRM), leukemia-free-survival (LFS), and overall survival (OS). Compared to PBSCT, BMT had lower neutrophil (HR, 2.08; 95% CI, 1.80 to 2.42; p < 0.00001) and platelet (HR, 2.77; 95% CI, 1.78 to 4.30; p < 0.00001) engraftment. BMT was associated with a significant decrease in the development of grades II-IV (HR, 0.75; 95% CI, 0.63 to 0.90; p = 0.002) and III-IV (HR, 0.63; 95% CI, 0.47 to 0.84; p = 0.001) acute GVHD as well as overall (HR, 0.70; 95% CI, 0.59 to 0.83; p < 0.0001) and extensive (HR, 0.60; 95% CI, 0.39 to 0.91; p = 0.002) chronic GVHD. BMT was associated with a higher incidence of relapse (HR, 1.91; 95% CI, 1.34 to 2.74; p = 0.0004). Comparable TRM (1.08; 95% CI, 0.56 to 2.10; p = 0.81), LFS (HR, 1.04; 95% CI, 0.83 to 1.30; p = 0.73), and OS (HR, 1.06; 95% CI, 0.81 to 1.39; p = 0.65) were demonstrated for both treatments. An inverse linear relationship was observed between the acute GVHD difference (PBSCT minus BMT) and the outcome of OS (p = 0.016). Our meta-analysis suggest that BMT leads to slower hematological recovery, increasing rates of relapse, and a lower risk of GVHD, but no significant difference in LFS and OS. A lower incidence of acute GVHD is associated with a superior OS.
对于异体造血干细胞移植（BMT）和外周血造血干细胞移植（PBSCT）治疗血液恶性肿瘤患者的移植结果，仍存在争议。为了评估 BMT 和 PBSCT 对血液恶性肿瘤患者临床结局的影响，我们对 17 项随机对照试验的生存时间数据进行了 meta 分析。检索了从 1972 年至 2010 年 7 月的 PubMed、EMBASE 和 Cochrane 对照试验中心注册库（CENTRAL），以及 2009 年 7 月前的会议论文集和参考文献列表，未对随机试验进行任何语言限制，以获取血液恶性肿瘤患者接受 BMT 和 PBSCT 后移植结果的详细信息。由两名独立的审查员提取数据。检查的结果包括植入、移植物抗宿主病（GVHD）、复发、移植相关死亡率（TRM）、无白血病生存（LFS）和总生存（OS）。与 PBSCT 相比，BMT 导致中性粒细胞（HR，2.08；95%CI，1.80 至 2.42；p<0.00001）和血小板（HR，2.77；95%CI，1.78 至 4.30；p<0.00001）植入延迟。BMT 与 II-IV 级（HR，0.75；95%CI，0.63 至 0.90；p=0.002）和 III-IV 级（HR，0.63；95%CI，0.47 至 0.84；p=0.001）急性 GVHD 的发生率降低以及总（HR，0.70；95%CI，0.59 至 0.83；p<0.0001）和广泛（HR，0.60；95%CI，0.39 至 0.91；p=0.002）慢性 GVHD 相关。BMT 与复发（HR，1.91；95%CI，1.34 至 2.74；p=0.0004）的发生率更高相关。两种治疗方法的 TRM（1.08；95%CI，0.56 至 2.10；p=0.81）、LFS（HR，1.04；95%CI，0.83 至 1.30；p=0.73）和 OS（HR，1.06；95%CI，0.81 至 1.39；p=0.65）相似。急性 GVHD 差异（PBSCT 减去 BMT）与 OS 之间存在线性反比关系（p=0.016）。我们的 meta 分析表明，BMT 导致血液学恢复较慢、复发率较高、GVHD 风险较低，但 LFS 和 OS 无显著差异。较低的急性 GVHD 发生率与更好的 OS 相关。
