No difference in graft-versus-host disease, relapse, and survival comparing peripheral stem cells to bone marrow using unrelated donors

Abstract

The clinical results in 107 patients receiving a peripheral blood stem cell (PBSC) graft mobilized by granulocyte colonystimulating factor (G-CSF) from HLA-A, -B, and -DR-compatible unrelated donors were compared to 107 matched controls receiving unrelated bone marrow (BM) transplants. Engraftment was achieved in 94% of the patients in both groups. The PBSC graft contained significantly more nucleated cells, CD34 ؉ , CD3 ؉ , and CD56 ؉ cells (P < .001), and resulted in a significantly shorter time-to-neutrophil (15 versus 19 days) and platelet engraftment (20 versus 27 days), compared to the BM control group (P < .001). Probabilities of acute graft-versus-host disease (GVHD) grades II to IV were 35% and 32% (not significant [NS]) and of chronic GVHD 61% and 76% (NS) in the PBSC and BM groups, respectively. There was no difference between the 2 groups in bacteremia, cytomegalovirus reactivation or disease, and fungal infection. The 3-year transplant-related mortality (TRM) rates were 42% in the PBSC group and 31% in the BM controls (P ‫؍‬ .7) and the survival rates were 46% and 51%, respectively. The probability of relapse was 25% and 31% in both groups (NS), resulting in diseasefree survival rates of 43% in the PBSC group and 46% in the BM controls (NS). In the multivariate analysis, early disease, acute GVHD grade 0 to I, and presence of chronic GVHD were independent factors associated with a better disease-free survival in this study. PBSC from HLAcompatible unrelated donors can be used safely as an alternative to BM for stem cell transplantation. (Blood. 2001;98: 1739-1745)

The changing scene of allogeneic stem cell transplantation for chronic myeloid leukemia—a report from the German Registry covering the period from 1998 to 2004

“…PBSC were already more frequently used than BM (38% vs. 62% of all SCTs), while the stem cell source (BM/PBSC) had no significant influence on survival in multivariate analyses. These data correspond to a retrospective study of Remberger et al, where PBSC and bone marrow from unrelated donors were associated with similar rates of GvHD, relapse, and survival [21]. In contrast, Elmaagacli et al found improved overall survival with PBSC as stem cell source (94% vs. 66%) due to a significantly improved immune reconstitution for PBSCT and a lower TRM consequently to infections and severe aGvHD [22].…”

PBSC vs BM grafts with myeloablative conditioning for unrelated donor transplantation in adults with high-risk ALL

“…Unfortunately, our study was not able to assess the impact of the graft source on transplantation outcomes according to disease status at transplantation, because only a few patients received transplantation beyond CR1. However, in line with other studies, [20][21][22][23][24][25][27][28][29] our data showed nearly identical outcomes in terms of relapse, NRM, DFS and OS between the two graft sources among transplants in CR1. Therefore, further follow-up with a sizable population is required to define the advantages of URD-SCT using PBSC compared with BM in advanced ALL.…”

“…Conversely, except for two studies, 26,28 there was no survival advantage for one graft type over another in the setting of URD-SCT for various hematologic malignancies. [20][21][22][23][24][25]27,29,40 This discrepancy may be attributable to the differences in the sensitivity of underlying disease to graftversus-leukemia effect. According to data from the European Group for Blood and Marrow Transplantation registry, 28 the authors retrospectively compared the use of PBSC (n = 1502) and BM (n = 760) only for AML transplants after myeloablative conditioning transplants URD-SCT.…”

“…However, few studies are available that compare the outcomes of PBSC vs BM transplants in the setting of URD-SCT. [20][21][22][23][24][25][26][27][28][29] Furthermore, an analysis of the long-term outcomes of URD-SCT according to the graft source has not yet been reported in adults with ALL. In order to determine which graft source is superior in adults with high-risk ALL, we compared the long-term outcomes of URD-SCT between PBSC and BM.…”

Antithymocyte globulin for the prevention of graft-versus-host disease after unrelated hematopoietic stem cell transplantation for acute myeloid leukemia: results from the multicenter German cooperative study group

“…With the use of peripheral blood stem cells, one would have expected more, not less extensive cGvHD. 28,29 The second important finding of this study relates to the cumulative relapse incidence in the three patient groups. Patients with ATG-F had the highest relapse risk (actuarial risk of relapse at 3 years 41%), followed by those without ATG (31%).…”