再生障碍性贫血的外周血干细胞移植与骨髓移植：一项系统评价和荟萃分析
Peripheral blood stem cell transplantation vs. bone marrow transplantation for aplastic anemia: a systematic review and meta-analysis.
作者信息
Zhang Zhao, Zhou Xianghui, Cheng Zhipeng, Hu Yu
机构信息
Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Front Med (Lausanne). 2023 Nov 22;10:1289180. doi: 10.3389/fmed.2023.1289180. eCollection 2023.
BACKGROUND
Hematopoietic stem cell transplantation (HSCT) is an effective treatment for aplastic anemia. Recently, peripheral blood stem cell transplantation (PBSCT) has gradually replaced traditional bone marrow transplantation (BMT). However, which graft source has a better therapeutic effect and prognosis for aplastic anemia (AA) remains unclear. Therefore, we conducted this systematic review and meta-analysis.
METHODS
We systematically searched PubMed, EMBASE, and the Cochrane Library without language limitations for studies using PBSCT or BMT for AA. Data were analyzed using the Open Meta-Analyst.
RESULTS
We identified 17 of 18,749 studies, including seven comparative reports and nine single-arm reports, with a total of 3,516 patients receiving HSCT (1,328 and 2,188 patients received PBSCT and BMT, respectively). The outcomes of the comparative studies showed similar 5-year overall survival [OS; relative risk (RR) = 0.867; 95% confidence interval (CI), 0.747-1.006], similar transplant-related mortality (RR = 1.300; 95%CI, 0.790-2.138), graft failure rate (RR = 0.972; 95%CI, 0.689-1.372) between the PBSCT group and the BMT group, while the PBSCT group had a significantly higher incidence of chronic graft-versus-host disease (GVHD; RR = 1.796; 95% CI, 1.571-2.053) and a higher incidence of grade IV acute GVHD (RR = 1.560; 95% CI, 1.341-1.816) compared to the BMT group. The outcomes of single-arm reports showed similar 3-year OS and incidences of chronic GVHD, acute II-IV GVHD, III-IV GVHD, transplant-related mortality and graft failure rate between PBSCT and BMT.
CONCLUSION
Before 2010, PBSCT was not superior to BMT in terms of 5-year OS, transplant-related mortality and graft failure rate, but it exhibited a higher risk of both chronic and acute GVHD. After 2010, PBSCT and BMT showed similar 3-year OS, GVHD risks, transplant-related mortality and graft failure rate. PB grafts are more suitable for HSCT of the AA for convenience and pain relief.
SYSTEMATIC REVIEW REGISTRATION
www.crd.york.ac.uk/PROSPERO/, CRD42023412467.
背景
造血干细胞移植（HSCT）是治疗再生障碍性贫血的有效方法。近年来，外周血干细胞移植（PBSCT）已逐渐取代传统的骨髓移植（BMT）。然而，对于再生障碍性贫血（AA）而言，哪种移植物来源具有更好的治疗效果和预后仍不明确。因此，我们进行了这项系统评价和荟萃分析。
方法
我们系统检索了PubMed、EMBASE和Cochrane图书馆，纳入使用PBSCT或BMT治疗AA的研究，无语言限制。使用Open Meta-Analyst对数据进行分析。
结果
我们从18749项研究中确定了17项，包括7项比较报告和9项单臂报告，共有3516例患者接受HSCT（分别有1328例和2188例患者接受PBSCT和BMT）。比较研究的结果显示，PBSCT组和BMT组的5年总生存率[OS；相对危险度（RR）=0.867；95%置信区间（CI），0.747-1.006]相似，移植相关死亡率（RR=1.300；95%CI，0.790-2.138）、移植物失败率（RR=0.972；95%CI，0.689-1.372）相似，而PBSCT组慢性移植物抗宿主病（GVHD）的发生率显著更高（RR=1.796；95%CI，1.571-2.053），IV级急性GVHD的发生率也高于BMT组（RR=1.560；95%CI，1.341-1.816）。单臂报告的结果显示，PBSCT和BMT之间的3年总生存率以及慢性GVHD、急性II-IV级GVHD、III-IV级GVHD、移植相关死亡率和移植物失败率的发生率相似。
结论
2010年前，在5年总生存率、移植相关死亡率和移植物失败率方面，PBSCT并不优于BMT，但它表现出更高的慢性和急性GVHD风险。2010年后，PBSCT和BMT的3年总生存率、GVHD风险、移植相关死亡率和移植物失败率相似。外周血移植物因方便和减轻疼痛更适合AA的HSCT。
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