Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers.

被引:735
作者
Bensinger, WI
Martin, PJ
Storer, B
Clift, R
Forman, SJ
Negrin, R
Kashyap, A
Flowers, MED
Lilleby, K
Chauncey, TR
Storb, R
Appelbaum, FR
Rowley, S
Heimfeld, S
Blume, K
机构
[1] Fred Hutchinson Canc Res Ctr, Clin Div, Seattle, WA 98104 USA
[2] Univ Washington, Div Oncol, Seattle, WA 98195 USA
[3] City Hope Natl Med Ctr, Div Hematol, Duarte, CA 91010 USA
[4] City Hope Natl Med Ctr, Div Bone Marrow Transplantat, Duarte, CA 91010 USA
[5] Stanford Univ, Div Bone Marrow Transplantat, Stanford, CA 94305 USA
关键词
D O I
10.1056/NEJM200101183440303
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: In recipients of allogeneic hematopoietic-cell transplants, peripheral-blood cells mobilized with the use of filgrastim (recombinant granulocyte colony-stimulating factor) engraft more rapidly than bone marrow. However, the relative effects of these techniques on the rates of acute and chronic graft-versus-host disease, overall survival, and disease-free survival have not been determined in randomized studies. Methods: Between March 1996 and July 1999, 172 patients (12 to 55 years of age) with hematologic cancer were randomly assigned to receive either bone marrow or filgrastim-mobilized peripheral-blood cells from HLA-identical relatives for hematopoietic rescue after the treatment of hematologic cancer with high doses of chemotherapy, with or without radiation. Results: The recovery of both neutrophils and platelets was faster with peripheral-blood cells than with marrow (P<0.001 for both comparisons). The cumulative incidence of grade II, III, or IV acute graft-versus-host disease at 100 days was 64 percent with peripheral-blood cells and 57 percent with marrow (hazard ratio, 1.21; 95 percent confidence interval, 0.81 to 1.81; P=0.35). The cumulative incidence of chronic graft-versus-host disease was 46 percent with peripheral-blood cells and 35 percent with marrow (hazard ratio, 1.16; 95 percent confidence interval, 0.71 to 1.90; P=0.54). The estimated overall probability of survival at two years was 66 percent with peripheral-blood cells and 54 percent with marrow (hazard ratio for death, 0.62; 95 percent confidence interval, 0.38 to 1.02; P=0.06). The rate of disease-free survival at two years was 65 percent with peripheral-blood cells and 45 percent with marrow (hazard ratio for relapse or death, 0.60; 95 percent confidence interval, 0.38 to 0.95; P=0.03). Conclusions: In patients given high-dose chemotherapy, with or without radiation, for the treatment of hematologic cancer, allogeneic peripheral-blood cells used for hematopoietic rescue restore blood counts faster than allogeneic bone marrow, without increasing the risk of graft-versus-host disease. (N Engl J Med 2001;344:175-81.) Copyright (C) 2001 Massachusetts Medical Society.
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页码:175 / 181
页数:7
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