Bone Marrow or Peripheral Blood for Reduced-Intensity Conditioning Unrelated Donor Transplantation
Bone Marrow or Peripheral Blood for Reduced-Intensity Conditioning Unrelated Donor Transplantation
复制标题
DOI：
10.1200/jco.2014.57.2446
复制
发表时间：
2015-02-01
影响因子：
45.3
通讯作者：
Champlin, Richard E.
中科院分区：
文献类型：
--
作者：
Eapen, Mary;Logan, Brent R.;Champlin, Richard E.
目的：目前还没有随机对照试验比较外周血（PB）和骨髓（BM）移植物在恶性血液病的低强度预处理（RIC）移植中的作用。由于免疫调节起着重要的作用，在维持临床缓解后RIC，我们假设，较高的移植物抗宿主病（GVHD）与PB移植可能提供一个生存的优势。建立了考克斯回归模型，以研究急性髓性白血病、骨髓增生异常综合征或非霍奇金淋巴瘤（三种最常见的非相关RIC移植适应症）患者PB（n = 887）相对于BM（n = 219）移植后的结局。2000年至2008年期间在美国进行了移植。预处理方案包括烷化剂和氟达拉滨，GVHD预防包括钙调神经磷酸酶抑制剂（CNI）与甲氨蝶呤（MTX）或霉酚酸酯（MMF）。（与总生存率相关的因素），与BM相比，PB移植后5年生存率无显著差异：34%对38%与CNI-MTX和27%对20%与CNI-MMF GVHD prophylax.ConclusionSurvival移植后的PB和BM是可比的非放射RIC方案的血液系统恶性肿瘤的设置。GVHD预防对生存率的影响值得进一步评价。(C)2014年美国临床肿瘤学会
PurposeThere have been no randomized trials that have compared peripheral blood (PB) with bone marrow (BM) grafts in the setting of reduced-intensity conditioning (RIC) transplantations for hematologic malignancy. Because immune modulation plays a significant role in sustaining clinical remission after RIC, we hypothesize that higher graft-versus-host disease (GVHD) associated with PB transplantation may offer a survival advantage.Patients and MethodsThe primary outcome evaluated was overall survival. Cox regression models were built to study outcomes after transplantation of PB (n = 887) relative to BM (n = 219) for patients with acute myeloid leukemia, myelodysplastic syndrome, or non-Hodgkin lymphoma, the three most common indications for unrelated RIC transplantation. Transplantations were performed in the United States between 2000 and 2008. Conditioning regimens consisted of an alkylating agent and fludarabine, and GVHD prophylaxis involved a calcineurin inhibitor (CNI) with either methotrexate (MTX) or mycophenolate mofetil (MMF).ResultsAfter adjusting for age, performance score, donor-recipient HLA-match, disease, and disease status at transplantation (factors associated with overall survival), there were no significant differences in 5-year rates of survival after transplantation of PB compared with BM: 34% versus 38% with CNI-MTX and 27% versus 20% with CNI-MMF GVHD prophylaxis.ConclusionSurvival after transplantation of PB and BM are comparable in the setting of nonirradiation RIC regimens for hematologic malignancy. The effect of GVHD prophylaxis on survival merits further evaluation. (C) 2014 by American Society of Clinical Oncology