Autologous or allogeneic peripheral blood stem cell transplantation for the malignant hematologic diseases in 53 cases / 中国组织工程研究

ABSTRACT

BACKGROUND:The prognosis of malignant hematologic diseases has improved greatly with the application of the hematopoietic stem cell transplantation. Peripheral blood stem cell transplantation (PBSCT) has been used as an alternative to bone marrow transplantation (BMT).OBJECTIVE:To observe curative effect and clinical outcome in 53 patients with hematological malignancy undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) or autologous peripheral blood stem cell transplantation (auto-PBSCT).DESIGN:Randomized controlled study.SETTING:BMT Center, Hematology Department of the First Affiliated Hospital of Zhengzhou University.PARTICIPANTS:From July 2003 to May 2006, 53 patients (33 males and 20 females) with a median age of 37 years underwent PBSCT. Thirty-five patients received allo-PBSCT, including 13 of acute myelocytic leukemia (AML), 7 of acute lymphocytic leukemia (ALL), 10 of chronic myelocytic leukemia (CML), 2 of multiple myeloma (MM), and 3 of myelodysplastic syndrome (MDS). Eighteen patients underwent auto-PBSCT, including 7 AML, 6 ALL, 2 MM, and 3 non-Hodgkin lymphoma (NHL). Thirty-three donors (20 males and 13 females) with a median age of 35 age in the allo-PBSCT were HLA-identical siblings, 2 donors (5.7%) had one mismatch. Sixteen allografts were sex mismatched. Study was authorized by the Ethic committee of the hospital, and all patients had signed an inform consent.METHODS:① PBSC were mobilized with granulocyte colony-stimulating factor (G-CSF) or chemotherapy combined with G-CSF. A median of 6.2×106 CD34+ cells/kg was infused for allo-PBSCT and 3.0×106 CD34+ cells/kg was infused for auto-PBSCT. Amended BU/CY was used as conditioning regimen in allo-PBSCT and MAC was used in auto-PBSCT. Methotrexate (MTX) combined with cyclosporine A (CsA) and mycophenolate mofetil (MMF) was used as graft-versus-host disease (GVHD) prophylaxis. ALG was used in 1 patient with 1 locus mismatched in allo-PBSCT. ② Time to engraftment was calculated from the time of transplantation to neutrophil recovery ≥ 0.5×109 L-1 and platelet recovery ≥ 20×109 L-1, GVHD and relapse were observed until 1 year of follow-up.MAIN OUTCOME MEASURES:① Time to neutrophil and platelet recovery; ② GVHD occurrence after transplantation; ③ outcome of treatment.RESULTS:All the 53 patients were analyzed. ① Engraftment of neutrophils (> 0.5×109 L-1) and platelets (> 20×109 L-1) was achieved at a median of 13 days for neutrophils and 19 days for platelets in auto-PBSCT, and 12 days and 15 days respectively in allo-PBSCT. ② In allo-PBSCT, I-VI acute GVHD occurred in 31.4% cases, and chronic GVHD developed in 71.4% cases. ③ The relapse rate was 38.9% in auto-PBSCT, and 5.7% in allo-PBSCT. CONCLUSION:PBSCT can provide rapid hematopoietic reconstitution. It is an important method to cure the malignant hematologic diseases.