Improved outcomes using G-CSF-mobilized blood and bone marrow grafts as the source of stem cells compared with G-PB after HLA-identical sibling transplantation in patients with acute leukemia
Improved outcomes using G-CSF-mobilized blood and bone marrow grafts as the source of stem cells compared with G-PB after HLA-identical sibling transplantation in patients with acute leukemia
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与 G-PB 相比，在急性白血病患者进行 HLA 相合同胞移植后，使用 G-CSF 动员的血液和骨髓移植物作为干细胞来源可改善预后
DOI：
10.1111/ctr.12225
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发表时间：
2013
影响因子：
2.1
通讯作者：
Huang Xiao-jun
中科院分区：
文献类型：
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作者：
Zhao Xiao-su;Chen Yao;Zhao Xiang-yu;Liu Dai-hong;Xu Lan-ping;Wang Yu;Han Wei;Chen Yu-hong;Chen Huan;Zhang Xiao-hui;Liu Kai-yan;Huang Xiao-jun
这项回顾性研究比较了98例急性白血病患者的移植结果。使用来自HLA相同同胞供体的G-CSF动员的骨髓和血液（G-BM &PB）或G-CSF动员的外周血（G-PB）进行异基因造血干细胞移植。G-BM &PB组和G-PB组显示出显著不同的中性粒细胞恢复率（中位数分别为15与14 d; p = 0.009），但血小板恢复率相似。G-BM &PB和G-PB队列中II-IV级急性移植物抗宿主病（aGVHD）的累积发生率相似（分别为16.2 ± 4.7% vs. 21.8 ± 7.4%; p = 0.676），但III-IV级aGVHD的发生率显著不同（分别为5.5 ± 3.1% vs. 18.9 ± 7.1%; p = 0.042）。G-BM &PB和G-PB队列显示慢性GVHD的累积发生率相似（cGVHD，分别为49.1 ± 5.7%和42.7 ± 6.8%; p = 0.465），治疗相关死亡的1年累积发生率（分别为16.5 ± 3.5%和24.4 ± 4.1%; p = 0.220）和5年累积复发率（分别为13.9 ± 4.8%和26.8 ± 7.2%; p = 0.113）。G-BM &PB组的5年无白血病生存概率（LFS）显著高于G-PB组（分别为77.8 ± 5.2% vs. 57.6 ± 8.6%; p = 0.023）。多变量分析将G-PB确定为III-IV级aGVHD和LFS的独立风险因素。我们的研究结果表明，与G-PB相比，G-BM和PB的HLA相合移植对急性白血病患者的临床结局具有上级优势。
This retrospective study compared the transplantation outcomes of 98 consecutive patients with acute leukemia. Allogeneic hematopoietic stem cell transplantation was performed using G‐CSF‐mobilized bone marrow and blood (G‐BM&PB) or G‐CSF‐mobilized peripheral blood (G‐PB) from HLA‐identical sibling donors. The G‐BM&PB and G‐PB groups displayed significantly different neutrophil recovery rates (medians of 15 vs. 14 d, respectively; p = 0.009) but similar platelet recovery rates. The cumulative incidences of grades II–IV acute graft‐versus‐host disease (aGVHD) in the G‐BM&PB and G‐PB cohorts were similar (16.2 ± 4.7% vs. 21.8 ± 7.4%, respectively; p = 0.676), but the incidences of grades III‐IV aGVHD were significantly different (5.5 ± 3.1% vs. 18.9 ± 7.1%, respectively; p = 0.042). The G‐BM&PB and G‐PB cohorts displayed similar cumulative incidences of chronic GVHD (cGVHD, 49.1 ± 5.7% vs. 42.7 ± 6.8%, respectively; p = 0.465), one‐yr cumulative incidences of treatment‐related mortality (16.5 ± 3.5% vs. 24.4 ± 4.1%, respectively; p = 0.220), and five‐yr cumulative incidences of relapse (13.9 ± 4.8% vs. 26.8 ± 7.2%, respectively; p = 0.113). The five‐yr probability of leukemia‐free survival (LFS) was significantly higher in the G‐BM&PB group than in the G‐PB group (77.8 ± 5.2% vs. 57.6 ± 8.6%, respectively; p = 0.023). Multivariate analysis identified G‐PB as an independent risk factor for grades III‐IV aGVHD and LFS. Our results suggest that HLA‐identical transplantation with G‐BM&PB results in superior clinical outcomes compared with G‐PB for patients with acute leukemia.