Get access

Bone marrow harvest versus peripheral stem cell collection for haemopoietic stem cell donation in healthy donors

  • Review
  • Intervention

Authors


Abstract

Background

Haemopoietic stem cells can be collected from a donor either as a bone marrow harvest or by peripheral blood collection. Both techniques have risks for the donor.

Objectives

The aim of this review was to identify the adverse effects of haemopoietic stem cell donation and to compare the tolerability and safety of the two methods.

Search methods

We searched bibliographic databases including the Cochrane Central Register of Controlled trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE and EMBASE up to May 2008. We also searched reference lists of articles and contacted experts in the field.

Selection criteria

Randomised controlled trials enrolling haemopoietic stem cell donors and evaluating the different methods of donating haemopoietic stem cells were eligible.

Data collection and analysis

Two authors independently screened studies for inclusion. We extracted data and evaluated methodological quality. Quantitative analysis was not possible for most outcomes, but where used we preferred random-effects models due to the variability between the included studies.

Main results

Six trials (807 donors) were eligible: all were substudies, or constituent parts of, larger randomised controlled trials of bone marrow and peripheral blood stem cell allogeneic transplantation. No included trial was designed solely to measure and assess the experience of stem cell donors. The donors in all studies were related to the stem cell recipient. Overall, both types of donors experienced pain subsequent to donation, and psychological morbidity. The trend was for bone marrow donors to experience more pain at the donation site, more overall adverse events, and more days of restricted activity. They were also more likely to require hospitalisation than peripheral blood stem cell donors. In contrast, peripheral blood stem cell donors experienced more pain prior to donation, which may be related to the pre-donation administration of granulocyte colony stimulating factor (G-CSF). The methodological quality of the studies was poor and indicated limitations due to the risk of selection and attrition bias. The proportion of donors from the parent trial not included in the donor substudies was also inadequately explained.

Authors' conclusions

The different short-term morbidities associated with each type of haemopoietic stem cell donation were clear, with bone marrow donors experiencing more pain and more restriction post-donation than peripheral blood donors. However, the studies were limited by their methodological quality, failure to provide long-term follow up (for which larger numbers of donors would be required) and a failure to apply consistent measures of quality of life in a way which allows more meaningful evaluation across studies.

摘要

背景

異體造血幹細胞移植骨髓和周邊血幹細胞收集之比較

造血幹細胞可收集自捐者的骨髓或是周邊血。兩種技術對捐贈者都有些風險。

目標

此篇文獻回顧的目標是要確認造血幹細胞捐贈之副作用並比較兩種收集方式的耐受性與安全性。

搜尋策略

我們搜尋了許多書目數據庫包含CENTRAL(Cochrane圖書館至2008年第二期) 、MEDLINE與EMBASE到2008年五月。我們亦搜尋文章上列出的參考文獻並與此範疇的專家連絡。

選擇標準

包含造血幹細胞捐者及評估不同造血幹細胞捐贈方式的隨機對照試驗都被納入。

資料收集與分析

兩位作者獨立的篩選可納入的研究。我們抽出資料並分析方法學的品質。因納入的試驗間的差異性,大多數的結果無法進行定量的分析,故我們運用隨機效果模式。

主要結論

六個研究(807位捐者)被納入: 全部皆是骨髓或周邊血幹細胞異體移植之隨機對照試驗的次分析或是部份組成。沒有一個試驗是單獨為了衡量與評估捐贈者的經驗。試驗中所有的捐者都是幹細胞受贈者的親屬。整體來說,兩種方式的捐贈者在捐贈完後都經歷到疼痛和心理上的影響。骨髓捐贈者有較多捐贈部位疼痛、整體副作用及較久生活作息限制的趨勢。他們亦較周邊血幹細胞捐者需要住院。相對而言,周邊血幹細胞捐者在捐贈前感受到較多的疼痛,這可能是因為捐贈前注射白血球生長因子(GCSF)的關係。 這些研究之方法的品質不好,故選擇偏差(selection bias) 退出偏差(attrition bias)可能暗示著結論的侷限性。原研究中的未納入次分析的捐贈者部份亦可能造成不當的解讀。

作者結論

造血幹細胞的個別捐贈方式相關之不同的短期病症是清楚的。骨髓的捐贈者比周邊血幹細胞捐者感受到較多的疼痛與捐後的限制。然而,這些研究因為方法的品質、無長期追蹤(需要大數量的捐者)與無法在各研究間以一致的方式評估的生活品質而造成可信度有限。

翻譯人

本摘要由慈濟醫院王佐輔翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

捐贈血液幹細胞給血液惡性疾病患者(如:血癌)作為幹細胞移植之健康捐贈者的經驗比較: 造血液幹細胞可以兩種方式收集: 從骨髓採集(在全身麻醉下直接由捐者的髖骨抽取幹細胞)或者是由周邊血幹細胞收集(在施打一個療程白血球生長激素後,以血液細胞分離機收集幹細胞)。兩種收集方式都常見。已有許多研究探討哪一種捐贈方式對受贈病患最好,然而以捐者經驗的觀點來考量捐贈方式的研究卻不多。如果對捐者可能將有長期的副作用,這樣的研究是很重要的。舉例來說,白血球生長素的長期副作用仍不清楚,但是有跡象顯示白血球生長素與骨髓發育不良症候群(MDS)有關連。然而,多數的情況下捐贈者可以決定自己想要捐贈幹細胞方式。這篇文獻回顧的目標是要從捐贈的角度來直接比較兩種血液幹細胞的捐贈,以了解捐者的感受。在這篇綜論,每一個捐贈者都是幹細胞受贈病患的兄弟姊妹。此論文包含六個研究(807個捐贈者)。這個回顧發現捐贈骨髓者較周邊血捐者在捐贈完數天內有較多捐贈部位(髖骨部份)疼痛、較久生活作息限制(如: 請病假) 、較多的住院日數及副作用。相對而言,周邊血幹細胞捐者較骨髓捐者在捐贈前感受到較多疼痛。這疼痛來自於白血球生長素的注射。所有的捐贈者在捐贈後都感受到疲勞、活力下降與焦慮。此文獻回顧有三點限制。首先,在兩個研究中有超過40%的捐贈者沒有完成試驗。第二,所有的研究都沒有長期的追蹤。第三,不同的研究使用不同的問卷來記錄捐贈者的情緒反應造成比較這六個研究結果的困難。更進一步包含更多捐贈者的研究將提供更多捐贈者感受的了解。

Plain language summary

A comparison of the healthy donor's experience of donating their blood stem cells to a patient who is to receive a stem cell transplant as treatment for cancer of their blood (e.g. leukaemia)

Blood stem cells are collected from a donor in two ways: either through a bone marrow harvest (direct retrieval of the stem cells from the donor's hip bones, under general anaesthetic) or a peripheral blood stem cell collection (retrieval of stem cells using a blood cell separator machine, following a course of granulocyte colony stimulating factor (G-CSF) injections). Both these methods of donation are common. Much research has explored which method of donation gives the best outcome to the patient, however there has not been a lot of research exploring these methods of donation from the donor's perspective. Such research is important if there is the possibility of long-term adverse events for the donor. For example, the long-term adverse events of G-CSF are not known, but there is the suggestion of a correlation between G-CSF and development of myelodysplastic syndrome (MDS). However, in many instances, donors are given a choice as to which method they would like to use to donate their stem cells. The aim of this review was to compare directly these two methods of blood stem cell donation from the donor's perspective, to understand the experiences of the donor. In this review, each donor was a sibling of the patient to whom they were donating blood stem cells.

Six trials (807 donors) were identified for this review. The review found that donors donating via a bone marrow harvest experienced more pain at the donation site (hip bone area) in the days following the donation, more days of restricted activity (e.g. sick days), more days in hospital and more side effects than donors donating through a peripheral blood stem cell harvest. In contrast, peripheral blood stem cell harvest donors experienced more pain prior to the donation of blood stem cells than bone marrow harvest donors. This pain was as a result of G-CSF administration. All donors had increased levels of tiredness and reduced levels of energy and anxiety following their donation.

There were three main limitations of this review. Firstly, in two trials more than 40% of the donors did not complete the trial. Secondly, there was no long-term follow up of the donors in any trial. Thirdly, the trials used different questionnaires to record the donors emotional experience of the donation procedure which made it difficult to compare the results of these measurements across the six trials. Further research, with larger numbers of included donors, would provide a greater understanding of the donation experience.

Get access to the full text of this article

Ancillary