Peripheral-Blood Stem Cells versus Bone Marrow from Unrelated Donors

被引：652

作者：

Anasetti, Claudio ^{[1
]}

Logan, Brent R. ^{[2
]}

Lee, Stephanie J. ^{[3
]}

Waller, Edmund K. ^{[4
]}

Weisdorf, Daniel J. ^{[5
]}

Wingard, John R. ^{[23
]}

Cutler, Corey S. ^{[8
]}

Westervelt, Peter ^{[9
]}

Woolfrey, Ann ^{[3
]}

Couban, Stephen ^{[10
]}

Ehninger, Gerhard ^{[12
]}

Johnston, Laura ^{[13
]}

Maziarz, Richard T. ^{[14
]}

Pulsipher, Michael A. ^{[15
]}

Porter, David L. ^{[16
]}

Mineishi, Shin ^{[17
]}

McCarty, John M. ^{[18
]}

Khan, Shakila P. ^{[6
]}

Anderlini, Paolo ^{[19
]}

Bensinger, William I. ^{[3
]}

Leitman, Susan F. ^{[20
]}

Rowley, Scott D. ^{[22
]}

Bredeson, Christopher ^{[11
]}

Carter, Shelly L. ^{[21
]}

Horowitz, Mary M. ^{[2
]}

Confer, Dennis L. ^{[7
]}

机构：

[1] Univ S Florida, Coll Med, H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL 33612 USA

[2] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[3] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA

[4] Emory Univ, Winship Canc Inst, Atlanta, GA 30322 USA

[5] Univ Minnesota, Med Ctr, Minneapolis, MN 55455 USA

[6] Mayo Clin, Rochester, MN USA

[7] Natl Marrow Donor Program, Minneapolis, MN USA

[8] Dana Farber Canc Inst, Boston, MA 02115 USA

[9] Washington Univ, Siteman Canc Ctr, St Louis, MO USA

[10] Dalhousie Univ, Halifax, NS, Canada

[11] Ottawa Hosp, Ottawa, ON, Canada

[12] Univ Hosp Dresden, Dresden, Germany

[13] Stanford Univ, Med Ctr, Stanford, CA 94305 USA

[14] Oregon Hlth & Sci Univ, Portland, OR 97201 USA

[15] Univ Utah, Primary Childrens Med Ctr, Salt Lake City, UT USA

[16] Univ Penn, Philadelphia, PA 19104 USA

[17] Univ Michigan, Ann Arbor, MI 48109 USA

[18] Virginia Commonwealth Univ, Massey Canc Ctr, Richmond, VA 23284 USA

[19] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[20] NIH, Bethesda, MD 20892 USA

[21] EMMES Corp, Rockville, MD USA

[22] Hackensack Univ, John Theurer Canc Ctr, Hackensack, NJ USA

[23] Univ Florida, Shands Canc Ctr, Gainesville, FL USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2012年 / 367卷 / 16期

关键词：

VERSUS-HOST-DISEASE; COLONY-STIMULATING FACTOR; TERM-FOLLOW-UP; RANDOMIZED-TRIAL; CHRONIC GRAFT; PROGENITOR CELLS; ALLOGENEIC TRANSPLANTATION; LEUKEMIA; RECIPIENTS; MALIGNANCIES;

D O I：

10.1056/NEJMoa1203517

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Randomized trials have shown that the transplantation of filgrastim-mobilized peripheral-blood stem cells from HLA-identical siblings accelerates engraftment but increases the risks of acute and chronic graft-versus-host disease (GVHD), as compared with the transplantation of bone marrow. Some studies have also shown that peripheral-blood stem cells are associated with a decreased rate of relapse and improved survival among recipients with high-risk leukemia. METHODS We conducted a phase 3, multicenter, randomized trial of transplantation of peripheral-blood stem cells versus bone marrow from unrelated donors to compare 2-year survival probabilities with the use of an intention-to-treat analysis. Between March 2004 and September 2009, we enrolled 551 patients at 48 centers. Patients were randomly assigned in a 1: 1 ratio to peripheral-blood stem-cell or bone marrow transplantation, stratified according to transplantation center and disease risk. The median follow-up of surviving patients was 36 months (interquartile range, 30 to 37). RESULTS The overall survival rate at 2 years in the peripheral-blood group was 51% (95% confidence interval [CI], 45 to 57), as compared with 46% (95% CI, 40 to 52) in the bone marrow group (P = 0.29), with an absolute difference of 5 percentage points (95% CI, -3 to 14). The overall incidence of graft failure in the peripheral-blood group was 3% (95% CI, 1 to 5), versus 9% (95% CI, 6 to 13) in the bone marrow group (P = 0.002). The incidence of chronic GVHD at 2 years in the peripheral-blood group was 53% (95% CI, 45 to 61), as compared with 41% (95% CI, 34 to 48) in the bone marrow group (P = 0.01). There were no significant between-group differences in the incidence of acute GVHD or relapse. CONCLUSIONS We did not detect significant survival differences between peripheral-blood stem-cell and bone marrow transplantation from unrelated donors. Exploratory analyses of secondary end points indicated that peripheral-blood stem cells may reduce the risk of graft failure, whereas bone marrow may reduce the risk of chronic GVHD. (Funded by the National Heart, Lung, and Blood Institute-National Cancer Institute and others; ClinicalTrials.gov number, NCT00075816.)

引用

页码：1487 / 1496

页数：10

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