Bone marrow transplantation
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Bone Marrow Transplant. · Aug 2003
Meta Analysis Comparative StudySurvival after HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials.
The impact of peripheral blood stem cell transplantation (PBSCT) on survival relative to bone marrow transplantation (BMT) remains poorly defined. Several randomized controlled trials (RCTs) comparing HLA-matched related PBSC- and BMT for patients with hematologic malignancies have been published, yielding differing results. We conducted a meta-analysis of published RCTs to more precisely estimate the effect of PBSCT on survival. ⋯ However, there was an association between the proportion of patients enrolled with advanced-stage disease and the summary odds ratio for mortality. The pooled estimate was 0.64 for studies where patients with intermediate/advanced disease comprised at least 25% of enrollment, and was 1.07 for the studies enrolling a smaller proportion. This finding substantiates results from previously published studies that have demonstrated a survival advantage with PBSCT limited to patients with advanced disease.
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Bone Marrow Transplant. · Aug 2003
Randomized Controlled Trial Comparative Study Clinical TrialFewer relapses and increased chronic GVHD in patients transplanted with blood stem cells: a 5-year follow-up in a single centre study.
A total of 61 consecutive adult patients with haematological malignancies with an HLA-identical or one antigen-mismatched haploidentical family donor were randomised to allogeneic transplantation with blood stem cells (BSC) or bone marrow (BM). The median observation time was 5 years. Apart from engraftment parameters and acute graft-versus-host disease (GVHD), transplant-related mortality (TRM), incidence and severity of chronic GVHD, relapse, leukaemia-free survival (LFS) and overall survival (OS) were recorded. ⋯ No difference in LFS and OS was observed. In conclusion, our study strongly indicates an enhanced graft-versus-leukaemia effect in BSC recipients, which is not expressed in increased survival. The increased chronic GVHD in these patients may contribute, but the relation is complex and not yet understood.
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Bone Marrow Transplant. · Aug 2003
ReviewHematopoietic stem cell transplantation for multiple sclerosis: finding equipoise.
Hematopoietic stem cell transplantation of multiple sclerosis is rapidly expanding. Success for this approach requires an understanding of the pathophysiology of multiple sclerosis and design of trials that select patients with active inflammatory disease, low disability scores, and avoidance of conditioning agents that may damage neural stem cell compartments or further compromise already injured axons.
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Bone Marrow Transplant. · Aug 2003
ReviewAllogeneic HSCT for autoimmune diseases: conventional conditioning regimens.
Allogeneic hematopoietic stem cell transplantation (HSCT) tests the hypothesis that the replacement of a 'diseased' autoreactive immunological and stem cell compartment with one that is not autoreactive (but potentially alloreactive) can cure severe autoimmune diseases. The primary risks of allogeneic HSCT are the morbidity and morality associated with delayed immune reconstitution and GVHD. Although the risk of complications and mortality is greater than autologous HSCT, studies of allogeneic HSCT should be conducted in selected cases because there is a greater potential for sustained remissions. This review will discuss the anticipated results from allogeneic HSCT by summarizing outcomes in aplastic anemia and chronic myelogenous leukemia as well as a brief description of Seattle's experience with allogeneic HSCT in the first two patients with systemic sclerosis.
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Bone Marrow Transplant. · Aug 2003
A prospective comparison of immune reconstitution in pediatric recipients of positively selected CD34+ peripheral blood stem cells from unrelated donors vs recipients of unmanipulated bone marrow from related donors.
Positively selected CD34(+) hematopoietic stem cells from unrelated donors (UD-HSCT) have been successfully transplanted, but little is known about immune reconstitution in this setting. Here we report a prospective comparison of immune reconstitution in recipients of UD-HSCT and of unmanipulated bone marrow from matched sibling donors (MSD-BMT). T-cell reconstitution occurred more than 100 days later in the UD-HSCT than in the MSD-BMT group. ⋯ In both groups, we observed transient expansions of gammadelta T cells. B cells were reconstituted more rapidly in UD-HSCT than in MSD-BMT recipients, whereas the rapidity of NK-cell reconstitution was similar in the two groups. In summary, T-cell reconstitution was slower after UD-HSCT than after MSD-BMT because of the delayed recovery of early memory-type T cells with reduced TCR-diversity, whereas naive T-, NK-, and B cells were reconstituted similarly in the two groups.