A randomized multicenter comparison of CD34+-selected progenitor cells from blood vs from bone marrow in recipients of HLA-identical allogeneic transplants for hematological malignancies

Cornelissen, Jan J.; Holt, Bronno van der; Petersen, Eefke; Vindeløv, Lars L.; Russel, Charlotte A.; Höglund, Martin; Maertens, Johan; Schouten, Harry C.; Braakman, Eric; Steijaert, Monique; Zijlmans, Mark; Slaper‐Cortenbach, Ineke; Boogaerts, Marc; Löwenberg, Bob; Verdonck, Leo F.

doi:10.1016/s0301-472x(03)00195-4

Cited by 51 publications

(28 citation statements)

References 37 publications

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“…These findings are in agreement with most of the published data. As limited cGVHD still exerts anti-neoplastic activity 30 with very little impairment of patients quality of life, several strategies to intensify GVHD prophylaxis have been reported, such as the administration of the full dose (four doses) of MTX, 31 the substitution of mycophenolate mofetil for MTX, 32 T-cell depletion and/or CD34 selection, 33,34 a longer period of CsA administration post transplant, 35 the use of additional drugs, such as rapamycin, 36 or polyclonal anti-lymphocyte antibodies. 37 Recently, the combination of tacrolimus and mycophenolate mofetil or MTX has been reported, 38,39 with promising results in the setting of non-MA transplants.…”

Section: Discussionmentioning

confidence: 99%

Intensification of GVHD prophylaxis with low-dose ATG-F before allogeneic PBSC transplantation from HLA-identical siblings in adult patients with hematological malignancies: results from a retrospective analysis

Bonifazi

Bandini

Arpinati

et al. 2011

Bone Marrow Transplant

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Several studies have shown that chronic GVHD (cGVHD) is more frequent in patients receiving transplants from PBSC than in those receiving BM. In the setting of PBSC-unrelated transplants, the addition of anti-T-cell globulin (ATG) has shown a significant decrease in incidence/severity of cGVHD, without an increase in relapses or infections. However, no prospective data are yet available in the sibling setting. We retrospectively analyzed the effects of intensification of standard GVHD prophylaxis (CsA þ MTX) by the addition of low-dose ATG in 245 patients receiving a transplant from HLA-identical sibling. From 1996 to 2001, patients received PBSC as the preferred source (group 2), and then ATG was added before transplant (group 3) because of a high cGVHD rate. Patients receiving BM in the same time period were analyzed as a control group (group 1). The incidence of grade IIIÀIV acute GVHD and cGVHD was not significantly different in the three groups, but extensive cGVHD was highest in group 2 (38%) compared with group 3 (21%) or group 1 (28%; P ¼ 0.03). OS, TRM and time to relapse/progression were similar in the three groups. Our analysis shows that adding ATG to PBSC sibling allogeneic transplants can lower cGVHD, without an increase of relapse. Further prospective studies are needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Intensification of GVHD prophylaxis with low-dose ATG-F before allogeneic PBSC transplantation from HLA-identical siblings in adult patients with hematological malignancies: results from a retrospective analysis

Bonifazi

Bandini

Arpinati

et al. 2011

Bone Marrow Transplant

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“…Table 1 presents the characteristics of all trials and patients considered in our analysis. Two trials differed substantially in the design from the rest: the Dutch trial 20 included T-cell depletion of the grafts, while the Australian trial 13 examined PBSCT versus granulocyte colony-stimulating factor primed BMT. It was unanimously agreed by all trialists that these trials should not be included in the pooled analysis.…”

Section: Trials and Patientsmentioning

confidence: 99%

Allogeneic Peripheral Blood Stem-Cell Compared With Bone Marrow Transplantation in the Management of Hematologic Malignancies: An Individual Patient Data Meta-Analysis of Nine Randomized Trials

Aljurf

Aranha

Annasetti

et al. 2005

JCO

405

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Purpose-Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies.Patients and Methods-To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results-Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR]= 0.31; 95% CI, 0.25 to 0.38; P < .00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P < .00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versushost disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P < .000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P < .000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage-(33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = . 02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = . 04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01).Conclusion-PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.

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“…2,3 Higher CD34 ϩ cell doses have been shown to correlate with more frequent chronic GVHD (cGVHD) following myeloablative AHCT, although several recent studies dispute this prognostic connection. [4][5][6][7] The influence of graft composition on clinical outcomes after reduced-intensity conditioning is less well-characterized. With emphasis shifting from myeloablative chemoradiation toward alloimmune effects of the graft, an understanding of the relationships, if any, between donor graft cell subpopulation contents and various outcomes may be particularly important.…”

Section: Introductionmentioning

confidence: 99%

Engraftment and survival following reduced-intensity allogeneic peripheral blood hematopoietic cell transplantation is affected by CD8+ T-cell dose

Cao

Shizuru

Wong

et al. 2005

Blood

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A randomized multicenter comparison of CD34+-selected progenitor cells from blood vs from bone marrow in recipients of HLA-identical allogeneic transplants for hematological malignancies

Cited by 51 publications

References 37 publications

Intensification of GVHD prophylaxis with low-dose ATG-F before allogeneic PBSC transplantation from HLA-identical siblings in adult patients with hematological malignancies: results from a retrospective analysis

Intensification of GVHD prophylaxis with low-dose ATG-F before allogeneic PBSC transplantation from HLA-identical siblings in adult patients with hematological malignancies: results from a retrospective analysis

Allogeneic Peripheral Blood Stem-Cell Compared With Bone Marrow Transplantation in the Management of Hematologic Malignancies: An Individual Patient Data Meta-Analysis of Nine Randomized Trials

Engraftment and survival following reduced-intensity allogeneic peripheral blood hematopoietic cell transplantation is affected by CD8+ T-cell dose

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