Granulocyte-colony-stimulating factor (G-CSF)-primed allogeneic bone marrow: significantly less graft-versus-host disease and comparable engraftment to G-CSF-mobilized peripheral blood stem cells
Granulocyte-colony-stimulating factor (G-CSF)-primed allogeneic bone marrow: significantly less graft-versus-host disease and comparable engraftment to G-CSF-mobilized peripheral blood stem cells
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DOI：
10.1182/blood.v98.12.3186
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发表时间：
2001-12-01
期刊：
影响因子：
20.3
通讯作者：
Durrant, S
中科院分区：
文献类型：
--
作者：
Morton, J;Hutchins, C;Durrant, S
前瞻性研究表明，使用粒细胞集落刺激因子动员的外周血干细胞（G-PBSC）进行同种异体移植可实现快速植入，但可能会增加移植物抗宿主病（GVHD）的风险。假设使用G-CSF预充骨髓（GBM）将允许快速植入，而与G-PBSC相比不会增加GVHD的风险。患者随机接受G-BM或G-PBSC进行异基因干细胞移植。该研究被设计（β < .8）以检测慢性GVHD发生率的差异为33%（< .05）。计划招募100例患者，并在前50例患者达到6个月随访点时进行中期分析。招募了57名连续患者（G-BM，n = 28; G-PBSC，n = 29）。G-PBSC组的患者接受了3倍多的CD 34（+）和9倍多的CD 3（+）细胞。中性粒细胞（G-BM，16天; G-PBSC，14天; P < .1）和血小板植入（G-BM，14天; G-PBSC，12天; P < .1）的中位时间相似。G-PBSC的使用与类固醇难治性急性GVHD（G-BM，0%; G-PBSC，32%; P < .001）、慢性GVHD（G-BM，22%; G-PBSC，80%; P < .02）和免疫抑制治疗的长期需求（G-BM，173天; G-PBSC，680天; P < .009）相关。两组的生存率相似。与G-PBSC相比，G-BM的使用导致相当的植入，急性GVHD的严重程度降低，以及随后的慢性GVHD减少。（血。2001;98：3186-3191）（C）2001由美国血液学学会。
Prospective studies have shown rapid engraftment using granulocyte-colony-stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) for allogeneic transplantation, though the risks for graft-versus-host disease (GVHD) may be increased. It was hypothesized that the use of G-CSF to prime bone marrow (GBM) would allow rapid engraftment without increased risk for GVHD compared with G-PBSC. Patients were randomized to receive G-BM or G-PBSCs for allogeneic stem cell transplantation. The study was designed (beta < .8) to detect a difference in the incidence of chronic GVHD of 33% ( < .05). The plan was to recruit 100 patients and to conduct an interim analysis when the 6-month follow-up point was reached for the first 50 patients. Fifty-seven consecutive patients were recruited (G-BM, n = 28; G-PBSC, n = 29). Patients in the G-PBSC group received 3-fold more CD34(+) and 9-fold more CD3(+) cells. Median times to neutrophil (G-BM, 16 days; G-PBSC, 14 days; P < .1) and platelet engraftment (G-BM, 14 days; G-PBSC, 12 days; P < .1) were similar. The use of G-PBSC was associated with steroid refractory acute GVHD (G-BM, 0%; G-PBSC, 32%; P < .001), chronic GVHD (G-BM, 22%; G-PBSC, 80%; P < .02), and prolonged requirement for immunosuppressive therapy (G-BM, 173 days; G-PBSC, 680 days; P < .009). Survival was similar for the 2 groups. Compared with G-PBSC the use of G-BM resulted in comparable engraftment, reduced severity of acute GVHD, and less subsequent chronic GVHD. (Blood. 2001;98:3186-3191) (C) 2001 by The American Society of Hematology.