外周血液干细胞移植与骨髓移植用于无塑性贫血:系统性审查和元分析
Zhao Zhang1, Xianghui Zhou1, Zhipeng Cheng1
1Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Frontiers in medicine
|December 11, 2023
概括
周围血液干细胞移植 (PBSCT) 和骨髓移植 (BMT) 在无塑性贫血 (AA) 患者中显示出类似的结果. PBSCT提供了更大的方便和缓解疼痛,使其成为AA中HSCT的合适选择.
科学领域:
- 血液学 血液学 血液学
- 移植免疫学 移植免疫学
背景情况:
- 造血干细胞移植 (HSCT) 是对无塑性贫血 (AA) 的关键治疗方法.
- 外周血液干细胞移植 (PBSCT) 越来越多地使用,可能取代传统的骨髓移植 (BMT).
- 关于PBSCT与BMT对AA的比较疗效和预后存在不确定性.
研究的目的:
- 系统地审查和分析比较PBSCT和BMT对无塑性贫血的研究.
- 澄清哪个移植来源提供更好的治疗效果和长期预后.
主要方法:
- 在PubMed,EMBASE和Cochrane图书馆的系统文献搜索,没有语言限制.
- 包括AA对HSCT的比较和单臂研究.
- 使用开放式元分析器进行数据分析.
主要成果:
- 对17项涉及3516名患者的研究 (1,328名PBSCT,2,188名BMT) 的分析.
- 对比研究显示,PBSCT和 BMT之间的5年总生存率 (OS),移植相关死亡率和移植失败率相似.
- 与BMT相比,PBSCT组显示慢性移植对宿主疾病 (GVHD) 和IV级急性GVHD的发病率显著更高.
结论:
- 在2010年之前,PBSCT在存活率或死亡率方面没有比 BMT更优越,但GVHD风险更高.
- 在2010年之后,PBSCT和 BMT在OS,GVHD,死亡率和移植失败方面显示出相似的结果.
- 由于方便和减少患者不适,建议在AA中进行HSCT的外周血液移植.
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