No difference in graft-versus-host disease, relapse, and survival comparing peripheral stem cells to bone marrow using unrelated donors.
The clinical results in 107 patients receiving a peripheral blood stem cell (PBSC) graft mobilized by granulocyte colony-stimulating 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 disease-free 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 HLA-compatible unrelated donors can be used safely as an alternative to BM for stem cell transplantation.
Remberger
M
M
Centre for Allogeneic Stem Cell Transplantation and Department of Clinical Immunology, Huddinge University Hospital, Stockholm, Sweden. mats.remberger@impi.ki.se
Ringdén
O
O
Blau
I W
IW
Ottinger
H
H
Kremens
B
B
Kiehl
M G
MG
Aschan
J
J
Beelen
D W
DW
Basara
N
N
Kumlien
G
G
Fauser
A A
AA
Runde
V
V
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000209:etiology; D001782:Blood Donors; D001803:Blood Transfusion; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000209:etiology; D012008:Recurrence; D016019:Survival Analysis