Solano C, Martinez C, Brunet S, Tomás J F, Urbano-Ispizua A, Zuazu J, Ojeda E, Bargay J, Moraleda J M, Bailen A, Sierra J, García-Conde J, Rozman C
Department of Hematology at Hospital Clínico, Valencia, Spain.
Bone Marrow Transplant. 1998 Dec;22(12):1129-35. doi: 10.1038/sj.bmt.1701500.
We retrospectively compared the incidence and clinical characteristics of cGVHD in 37 allo-PBT recipients transplanted between July 1994 and October 1996 and 37 historical control allo-BMT recipients in a case-control study. All patients received a first unmanipulated transplant, graft from an HLA-identical sibling donor, with CsA-MTX GVHD prophylaxis and survived more than 100 days after transplant. PBT and BMT groups were well matched for age, grade of acute GVHD, male patients grafted from female donors, and phase of disease. The median CD34+ and CD3+ cell numbers infused in the PBT group were 5.2 x 10(6)/kg and 307 x 10(6)/kg, respectively. The median time to an ANC greater than 0.5 x 10(9)/l was 16 days (range 11-22) after PBT and 22 days (range 14-36) after BMT (P < 0.001). The median time to a platelet count greater than 20 x 10(9)/l was 15 days (range 6-43) after PBT and 28 days (range 12-68) after BMT (P < 0.001). Median follow-up was 12.3 months (range 5.4-30.3) and 58.7 months (range 4-122.3), for patients receiving PBT and BMT, respectively. Seventeen out of 37 (46%) PBT recipients, vs nine out of 37 (24%) BM recipients developed cGVHD. Actuarial probability of cGVHD at 1 year was 59% (95% CI, 39-79) in the PBT group vs 27% (95% CI, 12-42) in the BM group (P = 0.01). Cumulative incidence estimate of cGVHD was 51% and 25%, for patients receiving PBT and BMT respectively (P = 0.03). Clinical characteristics of cGVHD and response to therapy were similar in both groups, except for a higher incidence of de novo cGVHD in the PBT group. Our results suggest that as compared with BMT, PBT may result in an increased incidence of cGVHD.
在一项病例对照研究中，我们回顾性比较了1994年7月至1996年10月期间接受移植的37例异基因外周血干细胞移植（allo-PBT）受者与37例历史对照异基因骨髓移植（allo-BMT）受者慢性移植物抗宿主病（cGVHD）的发生率及临床特征。所有患者均接受首次未处理的移植，供者为人类白细胞抗原（HLA）相合的同胞，采用环孢素A（CsA）-甲氨蝶呤（MTX）预防移植物抗宿主病（GVHD），且移植后存活超过100天。PBT组和BMT组在年龄、急性GVHD分级、女性供者向男性患者供髓以及疾病分期方面匹配良好。PBT组输注的CD34+和CD3+细胞数中位数分别为5.2×10⁶/kg和307×10⁶/kg。PBT后中性粒细胞绝对值（ANC）大于0.5×10⁹/L的中位时间为16天（范围11 - 22天），BMT后为22天（范围14 - 36天）（P<0.001）。PBT后血小板计数大于20×10⁹/L的中位时间为15天（范围6 - 43天），BMT后为28天（范围12 - 68天）（P<0.001）。接受PBT和BMT患者的中位随访时间分别为12.3个月（范围5.4 - 30.3个月）和58.7个月（范围4 - 122.3个月）。37例PBT受者中有17例（46%）发生cGVHD，而37例BMT受者中有9例（24%）发生cGVHD。PBT组1年时cGVHD的精算概率为59%（95%可信区间[CI]，39 - 79），BMT组为27%（95%CI，12 - 42）（P = 0.01）。接受PBT和BMT患者cGVHD的累积发生率估计分别为51%和25%（P = 0.03）。两组cGVHD的临床特征及对治疗的反应相似，只是PBT组新发cGVHD的发生率较高。我们的结果表明，与BMT相比，PBT可能导致cGVHD发生率增加。
