Impact of a Low CD34+ Cell Dose on Allogeneic Peripheral Blood Stem Cell Transplantation.-猫眼课题宝

DOI：

10.1016/j.bbmt.2017.10.043

发表时间：

2017-11

期刊：

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation

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通讯作者：

中科院分区：

其他

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作者：

Chihiro Yamamoto;H. Ogawa;T. Fukuda;A. Igarashi;H. Okumura;N. Uchida;M. Hidaka;H. Nakamae;K. Matsuoka;T. Eto;T. Ichinohe;Y. Atsuta;Y. Kanda

虽然异基因外周血干细胞移植（PBSCT）中的CD 34+细胞剂量被认为与移植结果相关，但尚未定义较低的可接受阈值。我们回顾性分析了2001年至2014年期间在日本接受相关PBSCT的2919例成人恶性血液病患者。根据移植物中CD 34+细胞的数量，我们将2494例患者分为标准组（2 ~ 5 × 106个细胞/kg），低组（1 ~ 2 × 106个细胞/kg）377例患者和极低组（<1 × 106个细胞/kg）48例患者。与标准组相比，低剂量组和极低剂量组显示中性粒细胞恢复延迟（+28天分别为93.8%、89.5%和78.3%;P< .001）和血小板恢复延迟（+28天分别为69.3%、53.0%和45.5%;P< .001）。3组的2年总生存率（OS）分别为45.5%、45.3%和29.8%，极低组的生存率较差。然而，高风险患者比例较高可能是极低风险组生存率较低的原因，多变量分析未发现OS存在显着差异。3组间复发、非复发死亡率或移植物抗宿主病发生率无差异。总之，低CD 34+细胞剂量（1 - 2 × 106个细胞/kg）的异基因PBSCT可获得可接受的结果，而由于该队列中具有不良预后因素的患者数量较少且百分比较高，因此需要进一步研究以评估<1 × 106个细胞/kg的较低剂量的影响。

Although the CD34+cell dose in allogeneic peripheral blood stem cell transplantation (PBSCT) is considered to be associated with transplantation outcomes, a lower acceptable threshold has not been defined. We retrospectively analyzed 2919 adult patients with hematologic malignancies who underwent related PBSCT in Japan between 2001 and 2014. According to the number of CD34+cells in the graft, we categorized 2494 patients in the standard group (2 to 5 × 106cells/kg), 377 patient in the low group (1 to 2 × 106cells/kg), and 48 patients in the very low group (<1 × 106cells/kg). Compared with the standard group, the low and very low groups showed delayed neutrophil recovery (93.8%, 89.5%, and 78.3%, respectively at day +28;P< .001) and platelet recovery (69.3%, 53.0%, and 45.5%, respectively at day +28;P< .001). The 2-year overall survival (OS) in the 3 groups was 45.5%, 45.3%, and 29.8%, respectively, with inferior survival in the very low group. However, a higher percentage of high-risk patients may account for the inferior survival in the very low group, and no significant difference in OS was found in a multivariate analysis. There were no differences in relapse, nonrelapse mortality, or the development of graft-versus-host disease among the 3 groups. In conclusion, allogeneic PBSCT with low CD34+cell doses of 1 to 2 × 106cells/kg gives acceptable results, whereas further investigations are needed to evaluate the effects of lower doses of <1 × 106cells/kg owing to the smaller number and the higher percentage of patients with adverse prognostic factors in this cohort.

Impact of a Low CD34+ Cell Dose on Allogeneic Peripheral Blood Stem Cell Transplantation.

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