Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions.
Comparing Outcomes with Bone Marrow or Peripheral Blood Stem Cells as Graft Source for Matched Sibling Transplants in Severe Aplastic Anemia across Different Economic Regions.
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DOI：
10.1016/j.bbmt.2016.01.012
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发表时间：
2016-05
期刊：
影响因子：
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通讯作者：
Saber W
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作者：
Kumar R;Kimura F;Ahn KW;Hu ZH;Kuwatsuka Y;Klein JP;Pasquini M;Miyamura K;Kato K;Yoshimi A;Inamoto Y;Ichinohe T;Wood WA Jr;Wirk B;Seftel M;Rowlings P;Marks DI;Schultz KR;Gupta V;Dedeken L;George B;Cahn JY;Szer J;Lee JW;Ho AY;Fasth A;Hahn T;Khera N;Dalal J;Bonfim C;Aljurf M;Atsuta Y;Saber W
与动员的外周血干细胞(PBSC)相比，骨髓(BM)是重型再生障碍性贫血(SAA)造血干细胞移植(HSCT)的首选移植来源。我们推测，这一建议可能不适用于患者病程较晚、输血负荷较重和移植物失败率较高的地区。对1995-2009年间接受HSCT的SAA患者进行了分析，这些患者接受了来自一名匹配的同胞捐献者的HSCT，并报告给了国际血液和骨髓移植研究中心或日本造血细胞移植学会。研究人口按人均国民总收入(国民总收入)和区域/国家分为四组。分析的群体是高收入国家(HIC)，这些国家又进一步分为美国-加拿大(N=486)和其他HIC(N=1264)、高中等收入(UMIC)(N=482)和低、中、低收入国家(LM-LIC)(N=142)。在多因素分析中，移植骨髓作为移植来源的HIC的总存活率(OS)高于所有国家的PBSC或UMIC或LM-LIC中的BM(p<；0.001)。在UMIC(p=0.32)和Lm-LIC(p=0.23)中，BM和PBSC的OS差异无统计学意义。在Lm-LIC中，PBSC移植28天的中性粒细胞植入率高于BM(97%vs.77%，p<；0.001)。慢性移植物抗宿主病在所有组的PBSC中均显著升高。在SAA中，骨髓绝对应该是HLA相合的同胞HSCT的首选移植来源，但在资源有限的国家，当治疗移植失败和感染性并发症的高风险患者时，PBSC可能是一种可接受的替代方案。
Bone marrow (BM) is the preferred graft source for hematopoietic stem cell transplantation (HSCT) in severe aplastic anemia (SAA) compared to mobilized peripheral blood stem cells (PBSC). We hypothesized that this recommendation may not apply to those regions where patients present later in their disease course, with heavier transfusion load and with higher graft failure rates. Patients with SAA who received HSCT from an HLA-matched sibling donor from 1995 to 2009 and reported to the Center for International Blood and Marrow Transplant Research or the Japan Society for Hematopoietic Cell Transplantation were analyzed. The study population was categorized by gross national income per capita (GNI) and region/countries into four groups. Groups analyzed were high income countries (HIC), which were further divided into US-Canada (N=486) and other HIC (N=1264), upper middle-income (UMIC) (N=482), and combined lower middle, low income countries (LM-LIC) (N=142). In multivariate analysis, overall survival (OS) was highest with BM as graft source in HIC compared to PBSC in all countries or BM in UMIC or LM-LIC (p<0.001). There was no significant difference in OS between BM and PBSC in UMIC (p=0.32) or LM-LIC (p=0.23). In LM-LIC the 28-day neutrophil engraftment was higher with PBSC compared to BM (97% vs. 77%, p<0.001). Chronic GVHD was significantly higher with PBSC in all groups. Whereas BM should definitely be the preferred graft source for HLA-matched sibling HSCT in SAA, PBSC may be an acceptable alternative in countries with limited resources when treating patients at high risk of graft failure and infective complications.