JCO:血液恶性肿瘤移植治疗,骨髓移植vs外周血移植

2017-06-27 xiaoxiao MedSci原创

正HLA单倍型相合造血干细胞移植(human leukocyte antigen-haploidentical hematopoietic stem cell transplantation,HLA-haplo HSCT)是大多数血液病患者可选择的一种移植方式,能够节约寻找供者的时间和花费。二十多年以来,多种单倍型相合移植方式,包括保留或去除T细胞的单倍型移植显示出了较好的预后。为了预防移植抗宿主

正HLA单倍型相合造血干细胞移植(human leukocyte antigen-haploidentical hematopoietic stem cell transplantation,HLA-haplo HSCT)是大多数血液病患者可选择的一种移植方式,能够节约寻找供者的时间和花费。二十多年以来,多种单倍型相合移植方式,包括保留或去除T细胞的单倍型移植显示出了较好的预后。为了预防移植抗宿主病(GVHD),大剂量移植后环磷酰胺(PTCy)已经改善了半相合造血干细胞(HAPLO)移植(SCT)后的结局。使用移植后环磷酰胺的保留T细胞的HLA半相合供体造血干细胞移植最初在骨髓(BM)中被描述。随着外周血(PB)移植的增加,研究人员比较了PB和BM移植后的移植结果。

在美国,2009-2014年间接受血液移植的681例血液恶性肿瘤患者被纳入该研究,这些患者曾接受骨髓移植(n=481)或外周血移植(n=190)。建立了Cox回归模型,通过移植类型、患者适应情况、疾病和移植特征来检查移植结果的差异。

研究发现,骨髓移植和外周血移植后造血功能恢复情况相似(28天内中性粒细胞水平恢复,88% vs 93%,p=0.07;100天内血小板水平恢复,88% vs 85%,p=0.33)。2-4级急性(危险比为0.45,p<0.001)和慢性(HR,0.35,p<0.001)的移植抗宿主病风险在骨髓移植中相比外周血移植较低。移植后的总存活率无显著差异(HR,0.99,p=0.98),移植后2年的存活率分别为54%和57%。非复发型死亡率风险无显著差异(HR,0.92;P =0.74),但骨髓移植后的复发型死亡风险风险较高(HR,1.49;P =0.009)。进一步的研究证实,骨髓移植后复发风险较高,仅限于白血病患者(HR,1.73,P =0.002),而非淋巴瘤患者(HR,0.87,P =0.64)。

骨髓移植和外周血移植适用于移植,但不同模式的治疗结果不同。虽然,这是最全面的比较,但这些发现必须在前瞻性、随机对照研究中得到充分的验证。

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    2018-05-21 lidong40
  2. [GetPortalCommentsPageByObjectIdResponse(id=1891379, encodeId=f18818913e9e6, content=<a href='/topic/show?id=25b0102e2df' target=_blank style='color:#2F92EE;'>#JCO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10272, encryptionId=25b0102e2df, topicName=JCO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Mon May 21 00:30:00 CST 2018, time=2018-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578526, encodeId=47cf15e85260c, content=<a href='/topic/show?id=fd724282021' target=_blank style='color:#2F92EE;'>#外周血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42820, encryptionId=fd724282021, topicName=外周血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a31916414168, createdName=ms3994565386320060, createdTime=Thu Jun 29 06:30:00 CST 2017, time=2017-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216079, encodeId=ef612160e91b, content=学习了,受益匪浅,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Jun 27 21:04:05 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216054, encodeId=0e2721605407, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Tue Jun 27 17:30:09 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216032, encodeId=47d7216032e6, content=好文章学习了:, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K1RUfOKQohib4bXhDtxVgOA9VcKY1LUZkCOmr0v3WupxANz2ibibNHkdevtSruvrhyI29IjXdtvUV48/0, createdBy=6ff82057534, createdName=139****5926, createdTime=Tue Jun 27 17:06:07 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1891379, encodeId=f18818913e9e6, content=<a href='/topic/show?id=25b0102e2df' target=_blank style='color:#2F92EE;'>#JCO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10272, encryptionId=25b0102e2df, topicName=JCO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Mon May 21 00:30:00 CST 2018, time=2018-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578526, encodeId=47cf15e85260c, content=<a href='/topic/show?id=fd724282021' target=_blank style='color:#2F92EE;'>#外周血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42820, encryptionId=fd724282021, topicName=外周血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a31916414168, createdName=ms3994565386320060, createdTime=Thu Jun 29 06:30:00 CST 2017, time=2017-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216079, encodeId=ef612160e91b, content=学习了,受益匪浅,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Jun 27 21:04:05 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216054, encodeId=0e2721605407, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Tue Jun 27 17:30:09 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216032, encodeId=47d7216032e6, content=好文章学习了:, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K1RUfOKQohib4bXhDtxVgOA9VcKY1LUZkCOmr0v3WupxANz2ibibNHkdevtSruvrhyI29IjXdtvUV48/0, createdBy=6ff82057534, createdName=139****5926, createdTime=Tue Jun 27 17:06:07 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
    2017-06-27 清风拂面

    学习了,受益匪浅,谢谢

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1891379, encodeId=f18818913e9e6, content=<a href='/topic/show?id=25b0102e2df' target=_blank style='color:#2F92EE;'>#JCO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10272, encryptionId=25b0102e2df, topicName=JCO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Mon May 21 00:30:00 CST 2018, time=2018-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578526, encodeId=47cf15e85260c, content=<a href='/topic/show?id=fd724282021' target=_blank style='color:#2F92EE;'>#外周血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42820, encryptionId=fd724282021, topicName=外周血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a31916414168, createdName=ms3994565386320060, createdTime=Thu Jun 29 06:30:00 CST 2017, time=2017-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216079, encodeId=ef612160e91b, content=学习了,受益匪浅,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Jun 27 21:04:05 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216054, encodeId=0e2721605407, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Tue Jun 27 17:30:09 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216032, encodeId=47d7216032e6, content=好文章学习了:, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K1RUfOKQohib4bXhDtxVgOA9VcKY1LUZkCOmr0v3WupxANz2ibibNHkdevtSruvrhyI29IjXdtvUV48/0, createdBy=6ff82057534, createdName=139****5926, createdTime=Tue Jun 27 17:06:07 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
    2017-06-27 Chongyang Zhang

    签到学习了很多。

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1891379, encodeId=f18818913e9e6, content=<a href='/topic/show?id=25b0102e2df' target=_blank style='color:#2F92EE;'>#JCO#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10272, encryptionId=25b0102e2df, topicName=JCO)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Mon May 21 00:30:00 CST 2018, time=2018-05-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578526, encodeId=47cf15e85260c, content=<a href='/topic/show?id=fd724282021' target=_blank style='color:#2F92EE;'>#外周血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=42820, encryptionId=fd724282021, topicName=外周血)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a31916414168, createdName=ms3994565386320060, createdTime=Thu Jun 29 06:30:00 CST 2017, time=2017-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216079, encodeId=ef612160e91b, content=学习了,受益匪浅,谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Tue Jun 27 21:04:05 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216054, encodeId=0e2721605407, content=签到学习了很多。, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Tue Jun 27 17:30:09 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=216032, encodeId=47d7216032e6, content=好文章学习了:, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K1RUfOKQohib4bXhDtxVgOA9VcKY1LUZkCOmr0v3WupxANz2ibibNHkdevtSruvrhyI29IjXdtvUV48/0, createdBy=6ff82057534, createdName=139****5926, createdTime=Tue Jun 27 17:06:07 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
    2017-06-27 139****5926

    好文章学习了:

    0

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