Bashey Asad, Zhang Mei-Jie, McCurdy Shannon R, St Martin Andrew, Argall Trevor, Anasetti Claudio, Ciurea Stefan O, Fasan Omotayo, Gaballa Sameh, Hamadani Mehdi, Munshi Pashna, Al Malki Monzr M, Nakamura Ryotaro, O'Donnell Paul V, Perales Miguel-Angel, Raj Kavita, Romee Rizwan, Rowley Scott, Rocha Vanderson, Salit Rachel B, Solh Melhem, Soiffer Robert J, Fuchs Ephraim Joseph, Eapen Mary
Asad Bashey, Melhem Solh, The Blood and Marrow Transplant Program at Northside Hospital, Atlanta, GA; Mei-Jie Zhang, Andrew St. Martin, Trevor Argall, Mehdi Hamadani, and Mary Eapen, Medical College of Wisconsin, Milwaukee, WI; Shannon R. McCurdy and Ephraim Joseph Fuchs, The Johns Hopkins Hospital, Baltimore, MD; Claudio Anasetti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Stefan O. Ciurea, MD Anderson Cancer Center, Houston, TX; Omotayo Fasan, The Center for Bone Marrow Transplantation at Geisinger Medical Center, Danville; Sameh Gaballa, Thomas Jefferson University Hospital, Philadelphia, PA; Pashna Munshi and Scott Rowley, MedStar Georgetown University Hospital, Washington, DC; Monzr M. Al Malki and Ryotaro Nakamura, City of Hope National Medical Center, Duarte, CA; Paul V. O'Donnell, Massachusetts General Hospital; Robert J. Soiffer, Dana-Farber Cancer Institute, Boston, MA; Miguel-Angel Perales, Memorial Sloan Kettering Cancer Center, New York, NY; Kavita Raj, King's College Hospital, London; Vanderson Rocha, Churchill Hospital, Oxford, United Kingdom; Rizwan Romee, Barnes Jewish Hospital, St Louis, MO; Scott Rowley, Hackensack University Medical Center, Hackensack, NJ; and Rachel B. Salit, Fred Hutchinson Cancer Research Center, Seattle, WA.
J Clin Oncol. 2017 Sep 10;35(26):3002-3009. doi: 10.1200/JCO.2017.72.8428. Epub 2017 Jun 23.
Purpose T-cell-replete HLA-haploidentical donor hematopoietic transplantation using post-transplant cyclophosphamide was originally described using bone marrow (BM). With increasing use of mobilized peripheral blood (PB), we compared transplant outcomes after PB and BM transplants. Patients and Methods A total of 681 patients with hematologic malignancy who underwent transplantation in the United States between 2009 and 2014 received BM (n = 481) or PB (n = 190) grafts. Cox regression models were built to examine differences in transplant outcomes by graft type, adjusting for patient, disease, and transplant characteristics. Results Hematopoietic recovery was similar after transplantation of BM and PB (28-day neutrophil recovery, 88% v 93%, P = .07; 100-day platelet recovery, 88% v 85%, P = .33). Risks of grade 2 to 4 acute (hazard ratio [HR], 0.45; P < .001) and chronic (HR, 0.35; P < .001) graft-versus-host disease were lower with transplantation of BM compared with PB. There were no significant differences in overall survival by graft type (HR, 0.99; P = .98), with rates of 54% and 57% at 2 years after transplantation of BM and PB, respectively. There were no differences in nonrelapse mortality risks (HR, 0.92; P = .74) but relapse risks were higher after transplantation of BM (HR, 1.49; P = .009). Additional exploration confirmed that the higher relapse risks after transplantation of BM were limited to patients with leukemia (HR, 1.73; P = .002) and not lymphoma (HR, 0.87; P = .64). Conclusion PB and BM grafts are suitable for haploidentical transplantation with the post-transplant cyclophosphamide approach but with differing patterns of treatment failure. Although, to our knowledge, this is the most comprehensive comparison, these findings must be validated in a randomized prospective comparison with adequate follow-up.
目的 最初描述的使用移植后环磷酰胺的T细胞充足的HLA单倍型相合供体造血移植是采用骨髓（BM）进行的。随着动员外周血（PB）的使用增加，我们比较了PB和BM移植后的移植结局。
患者与方法 2009年至2014年期间在美国接受移植的681例血液系统恶性肿瘤患者接受了BM（n = 481）或PB（n = 190）移植。构建Cox回归模型以检查移植类型对移植结局的差异，并对患者、疾病和移植特征进行校正。
结果 BM和PB移植后的造血恢复相似（28天中性粒细胞恢复率，88%对93%，P = 0.07；100天血小板恢复率，88%对85%，P = 0.33）。与PB移植相比，BM移植的2至4级急性（风险比[HR]，0.45；P < 0.001）和慢性（HR，0.35；P < 0.001）移植物抗宿主病风险更低。移植类型对总生存率无显著差异（HR，0.99；P = 0.98），BM和PB移植后2年的生存率分别为54%和57%。非复发死亡率风险无差异（HR，0.92；P = 0.74），但BM移植后的复发风险更高（HR，1.49；P = 0.009）。进一步探究证实，BM移植后较高的复发风险仅限于白血病患者（HR，1.73；P = 0.002），而非淋巴瘤患者（HR，0.87；P = 0.64）。
结论 PB和BM移植物适用于采用移植后环磷酰胺方法的单倍型相合移植，但治疗失败模式不同。尽管据我们所知，这是最全面的比较，但这些发现必须在充分随访的随机前瞻性比较中得到验证。
