title: Marrow versus peripheral blood for geno-identical allogeneic stem cell transplantation in acute myelocytic leukemia: influence of dose and stem cell source shows better outcome with rich marrow.
abstract: Several studies have compared bone marrow (BM) and peripheral blood (PB) as stem cell sources in patients receiving allografts, but the cell doses infused have not been considered, especially for BM. Using the ALWP/EBMT registry, we retrospectively studied 881 adult patients with acute myelocytic leukemia (AML), who received a non-T-depleted allogeneic BM (n = 515) or mobilized PB (n = 366) standard transplant, in first remission (CR1), from an HLA-identical sibling, over a 5-year period from January 1994. The BM cell dose ranged from 0.17 to 29 x 10(8)/kg with a median of 2.7 x 10(8)/kg. The PB cell dose ranged from 0.02 to 77 x 10(8)/kg with a median of 9.3 x 10(8)/kg. The median dose for patients receiving BM (2.7 x 10(8)/kg) gave the greatest discrimination. In multivariate analyses, high-dose BM compared to PB was associated with lower transplant-related mortality (RR = 0.61; 95% CI, 0.39-0.98; P =.04), better leukemia-free survival (RR = 0.65; 95% CI, 0.46-0.91; P =.013), and better overall survival (RR = 0.64; 95% CI, 0.44-0.92; P =.016). The present study in patients with AML receiving allografts in first remission indicates a better outcome with BM as compared to PB, when the dose of BM infused is rich.
authors.affiliation: Centre international greffes de moelle, Hopital Saint-Antoine, AP-HP, Paris, France. norbert-claude.gorin@sat.ap-hop-paris.fr
authors.forename: Norbert C
authors.initials: NC
authors.lastname: Gorin
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.forename: Meral
authors.initials: M
authors.lastname: Beksac
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Olle
authors.initials: O
authors.lastname: Ringden
authors.forename: Tapani
authors.initials: T
authors.lastname: Ruutu
authors.forename: Josy
authors.initials: J
authors.lastname: Reiffers
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bandini
authors.forename: Michele
authors.initials: M
authors.lastname: Falda
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Zikos
authors.forename: Roelf
authors.initials: R
authors.lastname: Willemze
authors.forename: Francesco
authors.initials: F
authors.lastname: Frassoni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001853:Bone Marrow / Q000502:physiology*; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012074:Remission Induction; D033581:Stem Cell Transplantation / Q000379:methods*; D013997:Time Factors; D014184:Transplantation, Homologous / Q000379:methods; D016896:Treatment Outcome