Sharma Nidhi, Faisal Muhammad Salman, Zhao Qiuhong, Jiang Justin, Elder Patrick, Benson Don M, Rosko Ashley, Chaudhry Maria, Bumma Naresh, Khan Abdullah, Devarakonda Srinivas, Vasu Sumithira, Jaglowski Samantha, Mims Alice S, Choe Hannah, Larkin Karilyn, Brammer Jonathan E, Wall Sarah, Grieselhuber Nicole, Saad Ayman, Penza Sam, Sigmund Audrey M, Efebera Yvonne A
Division of Hematology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA.
College of Medicine, The Ohio State University, Columbus, OH 43210, USA.
J Clin Med. 2021 Jun 27;10(13):2843. doi: 10.3390/jcm10132843.
Allogeneic hematopoietic cell transplantation (allo-HCT) from a haploidentical (haplo) donor has emerged as a suitable alternative in the absence of a matched donor. However, haplo-HCT patients have a higher risk of graft-versus-host disease (GVHD). Hence, bone marrow (BM) stem cell source and post-transplant cyclophosphamide (PTCy) have been routinely used to help mitigate this. Due to ease of collection, peripheral blood (PB) stem cells are increasingly being considered for haplo-HCT. We retrospectively analyzed 74 patients (42 BM and 32 PB) who underwent haplo-HCT at Ohio State University from 2009 to 2018. Median age at transplant was 60 years (yrs) for BM and 54 yrs for PB, ( = 0.45). There was no difference in OS ( = 0.13) and NRM ( = 0.75) as well as PFS ( = 0.10) or GRFS ( = 0.90) between the groups. The BM cohort showed a 3-year OS rate of 63% (95% confidence interval (CI): 46-76), and 3-year PFS of 49% (95% CI: 33-63). For the PB group, 3-year OS and PFS were 78% (95% CI: 59-89) and 68% (95% CI: 49-82), respectively. There were no differences in the incidence of acute GVHD (grade II-IV) ( = 0.31) and chronic GVHD ( = 0.18). Patients receiving BM had a significantly higher risk for relapse with relapse rates by 2 years at 36% (95% CI: 22-50) vs. 16% (95% CI: 6-31) for PB ( = 0.03). The findings from this study suggest that PB is an excellent alternative to BM for haplo-HCT.
在缺乏匹配供体的情况下，来自单倍体相合（haplo）供体的异基因造血细胞移植（allo-HCT）已成为一种合适的替代方案。然而，单倍体相合造血细胞移植患者发生移植物抗宿主病（GVHD）的风险较高。因此，骨髓（BM）干细胞来源和移植后环磷酰胺（PTCy）已被常规用于帮助减轻这种情况。由于采集方便，外周血（PB）干细胞越来越多地被考虑用于单倍体相合造血细胞移植。我们回顾性分析了2009年至2018年在俄亥俄州立大学接受单倍体相合造血细胞移植的74例患者（42例采用骨髓，32例采用外周血）。移植时骨髓组的中位年龄为60岁，外周血组为54岁（P = 0.45）。两组之间的总生存期（OS）（P = 0.13）、非复发死亡率（NRM）（P = 0.75）、无进展生存期（PFS）（P = 0.10）或粒细胞恢复时间（GRFS）（P = 0.90）均无差异。骨髓组的3年总生存率为63%（95%置信区间（CI）：46 - 76），3年无进展生存率为49%（95% CI：33 - 63）。外周血组的3年总生存率和无进展生存率分别为78%（95% CI：59 - 89）和68%（95% CI：49 - 82）。急性移植物抗宿主病（II - IV级）（P = 0.31）和慢性移植物抗宿主病（P = 0.18）的发生率无差异。接受骨髓移植的患者复发风险显著更高，骨髓组2年复发率为36%（95% CI：22 - 50），外周血组为16%（95% CI：6 - 31）（P = 0.03）。本研究结果表明，在外周血单倍体相合造血细胞移植中，外周血是骨髓的极佳替代物。
