Arcese W, Aversa F, Bandini G, De Vincentiis A, Falda M, Lanata L, Lemoli R M, Locatelli F, Majolino I, Zanon P, Tura S
Department of Cellular Biotechnology and Hematology, University La Sapienza, Rome.
Haematologica. 1998 Feb;83(2):159-82.
Peripheral blood stem cells (PBSC) are being increasingly used as an alternative to conventional allogeneic bone marrow (BM) transplantation. This has prompted the Working Group on CD34-Positive Hematopoietic Cells to evaluate the current utilization of allogeneic PBSC in clinical hematology.
The method employed for preparing this review was that of informal consensus development. Members of the Working Group met three times, and the participants at these meetings examined a list of problems previously prepared by the chairman. They discussed the single points in order to reach an agreement on different opinions and eventually approved the final manuscript. Some of the authors of the present review have been working in the field of stem cell transplantation and have contributed original papers in peer-reviewed journals. In addition, the material examined in the present review includes articles and abstracts published in journals covered by the Science Citation Index and Medline.
Review of the current literature shows that unmanipulated allogeneic PBSC give prompt and stable engraftment in HLA-identical sibling recipients. Despite the much higher number of T-cells infused, the incidence and severity of acute GVHD after PBSC transplant seems comparable to that observed with bone marrow (BM) cells. In comparison to the latter, PBSC probably ensure faster immunologic reconstitution in the early post-transplant period. Controversial results on the incidence and severity of acute-GVHD have been reported when CD34+ selection methods are used. Prospective randomized trials are underway to compare the results of PBSC and BM allogeneic transplantation. In mismatched family donor transplants, T-cell depleted PBSC successfully engraft immune-myeloablated recipients through a megacell-dose effect able to overcome the HLA barrier. Experience with PBSC in the context of unrelated donor transplants is currently anecdotal and prospective trials should be completed before that practice becomes routine. Finally, there is also limited evidence that, following induction chemotherapy, the addition of PBSC to donor lymphocyte infusion (DLI) for treatment of leukemia relapse after BMT may improve the safety and effectiveness of DLI itself. Concerning cord blood (CB) transplants, the most interesting aspects are the ease of CB collection and storage, the low risk of viral contamination and the low immune reactivity of CB cells. This last property has its clinical counterpart in an apparently reduced incidence and severity of acute GVHD both in sibling and unrelated CB transplants, probably making the level of donor/recipient HLA disparity acceptable a greater degree with respect to what is required for transplants from other sources.
外周血干细胞（PBSC）正越来越多地被用作传统异基因骨髓（BM）移植的替代方法。这促使CD34阳性造血细胞工作组评估异基因PBSC在临床血液学中的当前应用情况。
撰写本综述所采用的方法是达成非正式共识。工作组成员召开了三次会议，与会者审查了主席先前准备的一系列问题。他们逐一讨论了这些问题，以便就不同意见达成一致，并最终批准了最终稿件。本综述的一些作者一直在干细胞移植领域工作，并在同行评审期刊上发表了原创论文。此外，本综述所审查的材料包括发表在《科学引文索引》和《医学索引》收录期刊上的文章和摘要。
对当前文献的综述表明，未经过处理的异基因PBSC能在HLA匹配的同胞受者中迅速且稳定地植入。尽管输入的T细胞数量多得多，但PBSC移植后急性移植物抗宿主病（GVHD）的发生率和严重程度似乎与骨髓（BM）细胞移植时观察到的情况相当。与后者相比，PBSC可能确保移植后早期更快的免疫重建。当使用CD34+选择方法时，关于急性GVHD的发生率和严重程度报告了有争议的结果。正在进行前瞻性随机试验以比较PBSC和BM异基因移植的结果。在不匹配的家庭供体移植中，去除T细胞的PBSC通过能够克服HLA屏障的巨细胞剂量效应成功植入免疫清髓的受者体内。目前，无关供体移植中PBSC的经验只是个别情况，在这种做法成为常规之前应完成前瞻性试验。最后，也有有限的证据表明，在诱导化疗后，将PBSC添加到供体淋巴细胞输注（DLI）中用于治疗BMT后白血病复发，可能会提高DLI本身的安全性和有效性。关于脐血（CB）移植，最有趣的方面是CB采集和储存容易、病毒污染风险低以及CB细胞的免疫反应性低。这最后一个特性在临床中的体现是，在同胞和无关CB移植中，急性GVHD的发生率和严重程度明显降低，这可能使得供体/受体HLA不相配的程度在更大程度上可被接受，相对于来自其他来源的移植所需的程度而言。
