Allogeneic blood and bone-marrow stem-cell transplantation in haematological malignant diseases: a randomised trial.
BACKGROUND
Autologous transplantation with peripheral blood stem cells (PBSC) results in faster haematopoietic-cell repopulation than with bone marrow. We prospectively compared bone marrow and PBSC for allogeneic transplantation.


METHODS
Adult HLA-identical sibling donors provided bone marrow and lenograstim-mobilised PBSC. 39 patients with malignant haematological disorders were infused with either bone marrow (n=19) or PBSC (n=20) after standard conditioning regimens in a double-blind, randomised fashion. The identity of the infused products for all patients remained masked until 1 year after the last patient had received transplantation.


RESULTS
The PBSC group had significantly faster neutrophil recovery to 0.5x10(9)/L (median 17.5 vs 23 days, p=0.002), and platelet recovery to 20x10(9)/L (median 11 vs 18 days, p<0.0001) and to 50x10(9)/L (median 20.5 vs 27 days, p=0.02) than the bone-marrow group. PBSC patients were discharged from hospital earlier than were bone-marrow patients (median 26 vs 31 days, p=0.01). At 4 weeks after transplantation, absolute lymphocytes (0.48 vs 0.63, p=0.08) and CD25 cells (0.04 vs 0.08, p=0.007) were higher in the PBSC group, and the proportion of patients with absolute lymphopenia (74% vs 33%, p=0.03) and CD4 lymphopenia (59% vs 24%, p=0.05) was significantly higher in the bone-marrow group. There was no significant difference in the occurrence of acute or chronic graft-versus-host disease and overall survival. The probability of relapse was significantly higher in the bone-marrow group than in the PBSC group (p=0.01); all five relapses occurred among bone-marrow recipients.


CONCLUSIONS
Our small study indicates that PBSCs are better than bone marrow for allogeneic transplantation from HLA-identical siblings in terms of faster haematopoietic and immune recovery, and have the potential to reduce disease recurrence.
Powles
R
R
Leukaemia Unit, Royal Marsden Hospital, and Institute of Cancer Research, Sutton, Surrey, UK. leukaemia@clara.net
Mehta
J
J
Kulkarni
S
S
Treleaven
J
J
Millar
B
B
Marsden
J
J
Shepherd
V
V
Rowland
A
A
Sirohi
B
B
Tait
D
D
Horton
C
C
Long
S
S
Singhal
S
S
D000328:Adult; D001792:Blood Platelets / Q000378:metabolism; D016026:Bone Marrow Transplantation; D004311:Double-Blind Method; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control*; D019337:Hematologic Neoplasms / Q000517:prevention & control* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D011446:Prospective Studies; D012008:Recurrence; D033581:Stem Cell Transplantation