| Objective: Hematopoietic stem cell transplantation(HSCT) have made patients with hematological malignancies longer life and even heal up. Originally, bone marrow transplantation(BMT) was widely used in hematological malignancies. In recent two decades, peripheral blood stem cell transplantation has been more and more an important choice to treat malignant hemopathy except BMT. Because of the use of Granulocyte Colony-stimulating Factor, less immediate morbidity associated with stem-cell procurement, shorter hospitalization time and quicker immune reconstitution, HSCT has been well recognized. However, the difference of clinical effect between the two methods has not been totally clear. Although many studies reported the comparison of PBSCT and BMT, but conclusions were controversial including: a/c GVHD, disease-free survival, relapse, transplant related mortality, and overall survival.The objective of the present study was to analyze the difference of outcomes between PBSCT and BMT.Method: There were 329 literatures were obtained from Pub Med,EMBASE,CENTRAL and so on, which were published from 1999 to 2015. Inclusion criteria:qualified randomized controlled trial(RCT) in which the patients with hematologic malignancies, HLA-matched sibling donors, patients were randomly divided into the PBSCT group and BMT group, data were complete, different treatment groups were consistent and balanced, the data was regarded as valid, the demographic variables of the patients in either treatment group were not significantly different. Trials with poor quality data, experimental design or insufficient information were excluded. Two reviewers selected twelve RCTs in all, then screened out relevant data. Finally, a totalof 12 RCTs for BMT and PBSCT procedures were selected. We analyzed the data with the software of Rev Man 5.2. The quality of heterogeneity was evaluated using the I2 statistic of 50% as the critical value. If the fixed effects model had considerable heterogeneity. The funnel plot and Berger’s rank correlation method were also applied.Results: These 12 papers reported OS for all 1,805 patients with hematological malignancies in two transplantation groups. The OS in BMT group showed no significant difference with that in PBSCT group [RR, 1.05; 95%CI,(0.95 – 1.17);p=0.31]. DFS in BMT group was higher than that found in PBSCT group [RR, 1.61;95%CI,(1.23–2.11); P=0.0006]. The incidences of both a GVHD [RR, 0.87; 95% CI,(0.77–0.99); p=0.03] and c GVHD [OR, 0.52; 95% CI,(0.43–0.63); p<0.00001] in BMT group were lower than those in PBSCT group. The rates of relapse in BMT group were higher than that found in PBSCT group [RR, 1.49; 95%CI,(1.12–2.00);p=0.007]. No significant difference of the rates of relapse mortality were observed between the two groups [RR, 1.18; 95%CI,(0.93 – 1.48); p=0.17]. No significant difference of the rates of non-relapse mortality were observed between the two groups[RR, 0.99; 95%CI,(0.83–1.18); p=0.90]. Funnel plot and Berger’s rank correlation analysis showed no publication bias(P = 0.31).Conclusion: The study was a analysis of RCTs of the two treatments, and showed that as compared with the PBSCT group, the total OS in the BMT group presented no significant difference, the three-year DFS was higher. The incidence of both a GVHD and c GVHD were lower in the BMT group. Neither the rates of relapse mortality nor the rates of the non-relapse mortality showed significant difference.However, the PBSCT group showed lower rate of relapse as compared with the BMT group.BMT and PBSCT were all effective in hematological malignancies, the total OS in the two group presented no significant difference. But we should pay more attention to GVHD in PBSCT. |
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