骨髓移植与外周血造血干细胞移植治疗恶性血液病疗效的Meta分析

Bone marrow transplantation compared with peripheral blood stem cell transplantation in treatment of patients with hematologic malignancies: A meta-analysis based on randomized controlled trials

目的对骨髓移植（bone marrow transplantation,BMT）与外周血造血干细胞移植（peripheral blood stem cell transplantation,PBSCT）治疗恶性血液病的疗效进行Meta分析。方法检索1999-2015年来源于Pub Med、EMBASE和CENTRAL等数据库的相关文献共329篇,两个评审员独自确定文献是否达到入选标准,并评估文献的试验方法质量,最后挑选12个相关随机对照实验进行分析,共包含921例接受BMT治疗患者及884例接受PBSCT治疗患者。Rev Man5.2软件评估总生存期、无病生存期、移植物抗宿主病、复发率、复发死亡率、非复发死亡率等。结果 BMT组与PBSCT组总生存率差异无统计学意义（44.95%vs 42.87%,RR：1.05,95%CI：0.95-1.17,P=0.09）,但BMT组3年总生存率低于PBSCT组（42.38%vs51.02%,RR：0.83,95%CI：0.70-0.99,P=0.04）;BMT组3年无病生存率高于PBSCT组（47.89%vs 29.82%,RR：1.61,95%CI：1.23-2.11,P=0.000 6）;BMT组急性移植物抗宿主病和慢性移植物抗宿主病的发生率均低于PBSCT组（42.20%vs48.13%,RR：0.87,95%CI：0.77-0.99,P=0.003;46.95%vs 61.89%,RR：0.52,95%CI：0.43-0.63,P〈0.000 01）;BMT组复发率高于PBSCT组（18.90%vs 12.58%,RR：1.49,95%CI：1.12-2.00,P=0.007）,BMT组复发死亡率及非复发死亡率与PBSCT组均无统计学差异（15.08%vs 12.92%,RR：1.18,95%CI：0.93-1.48,P=0.17;22.34%vs 22.58%,RR：0.99,95%CI：0.83-1.18,P=0.90）。结论接受BMT治疗患者的3年总生存率及移植物抗宿主病发生率低于PBSCT治疗患者,无病生存率及复发率高于PBSCT治疗患者,而两种治疗方法的复发死亡率、非复发死亡率无显著差异。

Objective To compare the efficacy of peripheral blood stem cell transplantation（PBSCT） and bone marrow transplantation（BMT） in treatment of malignant hemopathy. Methods A total of 329 literatures published from 1999 to 2015 were obtained from Pub Med, EMBASE, CENTRAL, etc. Two reviewers independently identified the eligible studies and assessed the methodology of included trials. Twelve RCTs were selected, including 921 patients treated with BMT, and 884 patients treated with PBSCT. Overall survival, disease-free survival, graft-versus-host disease, relapse rate, relapse mortality, non-relapse mortality were analyzed by Rev Man 5.2 software. Results There was no significant difference in overall survival, relapse mortality and non-relapse mortality between two groups（44.95% vs 42.87%, RR： 1.05, 95% CI： 0.95-1.17, P=0.09; 15.08% vs 12.92%, RR： 1.18, 95% CI： 0.93-1.48, P=0.17; 22.34% vs 22.58%, RR： 0.99, 95% CI： 0.83-1.18, P=0.90）. The overall survival of more than 3 years, the incidence of acute graft-versus-host disease and chronic graft-versus-host disease in BMT group were significantly lower than PBSCT group（42.38% vs 51.02%, RR： 0.83, 95% CI： 0.70-0.99, P=0.04; 42.20% vs 48.13%, RR： 0.87, 95% CI： 0.77-0.99, P=0.003; 46.95% vs 61.89%, RR： 0.52, 95% CI： 0.43-0.63, P〈0.000 01）, however, the disease-free survival and rates of relapse in BMT group were significantly higher than PBSCT group（47.89% vs 29.82%, RR： 1.61, 95% CI： 1.23-2.11, P=0.0006; 18.90% vs 12.58%, RR： 1.49, 95% CI： 1.12-2.00, P=0.007]. Conclusion The overall survival of more than 3 years and incidence of graft-versus-host disease in patients treated with BMT are lower than patients treated with PBSCT, but the disease-free survival and rates of relapse in patients treated with BMT are higher than patients treated with PBSCT. There is no significant difference in relapse mortality and non-relapse mortality between two methods.