Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Immunol. 2022 Sep 15;13:993419. doi: 10.3389/fimmu.2022.993419. eCollection 2022.
To determine the influence of graft composition in haplo-HSCT, we summarized the long-term consequences of 251 consecutive transplantations from haploidentical donors. For donor-recipient HLA3/6-matched setting, 125 cases used G-CSF-mobilized BM and PBSCs mixtures, while 126 cases only used G-CSF-mobilized PBSCs in HLA4/6-matched transplantation. On the one hand, we wanted to explore the effect of harvests (CD34+ cells and TNCs dosages) on transplantation outcome in the context of haplo-HSCT no matter HLA4/6 or HLA3/6-matched setting. On the other hand, for patients using G-CSF-mobilized BM and PBSCs combination in HLA3/6-matched setting, we attempted to analyze whether TNCs or CD34+ cells from G-CSF-mobilized BM or G-CSF-mobilized PBSCs play the most paramount role on transplantation prognosis. Collectively, patients with hematologic malignancies receiving G-CSF-primed BM and PBSCs harvests had comparable consequences with patients only receiving G-CSF-mobilized PBSCs. Moreover, when divided all patients averagely according to the total amount of transfused nucleated cells, 3-year TRM of the intermediate group (13.06-18.05×10/kg) was only 4.9%, which was remarkably reduced when compared to lower and higher groups with corresponding values 18.3%, 19.6% (=0.026). The 3-year probabilities of OS and DFS of this intermediate group were 72.6% and 66.5%, which were slightly improved than the lower and higher groups. Most importantly, these data suggest that the transfused nucleated cells from G-CSF-primed BM above than 5.20×10/kg could achieve remarkably lower TRM in haplo-HSCT receiving G-CSF-mobilized BM and PBSCs harvests. These encouraging results suggested that we could improve the efficacy of haplo-HSCT by adjusting the component and relative ratio of transfused graft cells. Nevertheless, the above findings should be confirmed in a randomized prospective comparative research with adequate follow-up.
为了确定移植物成分在单倍体 HSCT 中的影响，我们总结了 251 例连续来自单倍体供体的移植的长期后果。在供受者 HLA3/6 匹配的情况下，125 例使用 G-CSF 动员的 BM 和 PBSCs 混合物，而 126 例仅在 HLA4/6 匹配的移植中使用 G-CSF 动员的 PBSCs。一方面，我们希望探讨在 HLA4/6 或 HLA3/6 匹配的情况下，无论收获物（CD34+细胞和 TNC 剂量）如何，对单倍体 HSCT 移植结果的影响。另一方面，对于在 HLA3/6 匹配设置中使用 G-CSF 动员的 BM 和 PBSCs 组合的患者，我们试图分析 G-CSF 动员的 BM 或 G-CSF 动员的 PBSCs 中的 TNC 或 CD34+细胞是否对移植预后起最重要的作用。总的来说，接受 G-CSF 预处理的 BM 和 PBSCs 采集的血液系统恶性肿瘤患者与仅接受 G-CSF 动员的 PBSCs 的患者具有相似的结果。此外，当根据输注的有核细胞总量平均分配所有患者时，中间组（13.06-18.05×10/kg）的 3 年 TRM 仅为 4.9%，与相应值为 18.3%和 19.6%的较低和较高组相比，显著降低（=0.026）。中间组的 3 年 OS 和 DFS 概率分别为 72.6%和 66.5%，略高于较低和较高组。最重要的是，这些数据表明，在接受 G-CSF 动员的 BM 和 PBSCs 采集的单倍体 HSCT 中，输注的 G-CSF 预处理的 BM 中的有核细胞超过 5.20×10/kg 可以显著降低 TRM。这些令人鼓舞的结果表明，我们可以通过调整输注移植物细胞的成分和相对比例来提高单倍体 HSCT 的疗效。然而，上述发现需要在具有足够随访的随机前瞻性对照研究中得到证实。
