Transplantation of Bone Marrow as Compared with Peripheral-Blood Cells from HLA-Identical Relatives in Patients with Hematologic Cancers

作者：William Bensinger, Paul J. Martin, Barry E. Storer, Reginald A. Clift, Steven J. Forman, Robert S. Negrin, Ashwin Kashyap, Mary E.D. Flowers, Kathy Lilleby, Thomas R. Chauncey, Rainer F Storb, Karl G. Blume, Shelly Heimfeld, Scott D. Rowley, Frederick R. Appelbaum · 发表于：New England Journal of Medicine · 年份：2001 · DOI：10.1056/nejm200101183440303 · 被引用次数：966 · 研究领域：Hematopoietic Stem Cell Transplantation、Neutropenia and Cancer Infections、Inflammatory Biomarkers in Disease Prognosis

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 m...