Mobilized Peripheral Blood Stem Cells Versus Unstimulated Bone Marrow As a Graft Source for T-Cell-Replete Haploidentical Donor Transplantation Using Post-Transplant Cyclophosphamide
Mobilized Peripheral Blood Stem Cells Versus Unstimulated Bone Marrow As a Graft Source for T-Cell-Replete Haploidentical Donor Transplantation Using Post-Transplant Cyclophosphamide
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DOI：
10.1200/jco.2017.72.8428
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发表时间：
2017-09-01
影响因子：
45.3
通讯作者：
Eapen, Mary
中科院分区：
文献类型：
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作者：
Bashey, Asad;Zhang, Mei-Jie;Eapen, Mary
目的T细胞充足的HLA半相合供者移植后使用环磷酰胺的造血移植最初是用骨髓（BM）进行的。随着越来越多地使用动员外周血（PB），我们比较PB和BM transplants.Patients和MethodsA共681例恶性血液病患者谁在2009年和2014年之间在美国接受移植BM（n = 481）或PB（n = 190）移植后的移植结果。建立考克斯回归模型，以检查移植物类型的移植结果的差异，调整患者，疾病，和transplantfeature.ResultsHematopoietic恢复是相似的BM和PB移植后（28天中性粒细胞恢复，88%v93%，P = 0.07; 100天血小板恢复，88%v85%，P = 0.33）。与PB相比，BM移植的2 - 4级急性（风险比[HR]，0.45; P，.001）和慢性（HR，0.35; P，.001）移植物抗宿主病的风险较低。移植物类型的总生存率无显著差异（HR，0.99; P = 0.98），BM和PB移植后2年的生存率分别为54%和57%。在非复发死亡风险方面没有差异（HR，0.92; P =.74），但骨髓移植后复发风险较高（HR，1.49; P =.009）。额外的探索证实，较高的复发风险移植后的BM仅限于白血病患者（HR，1.73; P =.002），而不是淋巴瘤（HR，0.87; P =.64）conclusionPB和BM移植物是适合单倍体相合移植与移植后环磷酰胺的方法，但不同的模式治疗失败。尽管据我们所知，这是最全面的比较，但这些发现必须在美国临床肿瘤学会2017年进行的具有充分随访的随机前瞻性比较中得到验证。
PurposeT-cell-replete HLA-haploidentical donor hematopoietic transplantation using post-transplant cyclophosphamide was originally described using bone marrow (BM). With increasing use of mobilized peripheral blood (PB), we compared transplant outcomes after PB and BM transplants.Patients and MethodsA total of 681 patients with hematologic malignancy who underwent transplantation in the United States between 2009 and 2014 received BM (n = 481) or PB (n = 190) grafts. Cox regression models were built to examine differences in transplant outcomes by graft type, adjusting for patient, disease, and transplant characteristics.ResultsHematopoietic recovery was similar after transplantation of BM and PB (28-day neutrophil recovery, 88% v 93%, P =.07; 100-day platelet recovery, 88% v 85%, P =.33). Risks of grade 2 to 4 acute (hazard ratio [HR], 0.45; P,.001) and chronic (HR, 0.35; P,.001) graft-versus-host disease were lower with transplantation of BM compared with PB. There were no significant differences in overall survival by graft type (HR, 0.99; P =.98), with rates of 54% and 57% at 2 years after transplantation of BMand PB, respectively. There were no differences in nonrelapse mortality risks (HR, 0.92; P =.74) but relapse risks were higher after transplantation of BM (HR, 1.49; P =.009). Additional exploration confirmed that the higher relapse risks after transplantation of BM were limited to patients with leukemia (HR, 1.73; P =.002) and not lymphoma (HR, 0.87; P =.64).ConclusionPB and BM grafts are suitable for haploidentical transplantation with the post-transplant cyclophosphamide approach but with differing patterns of treatment failure. Although, to our knowledge, this is the most comprehensive comparison, these findings must be validated in a randomized prospective comparison with adequate followc (C) 2017 by American Society of Clinical Oncology