title: Survival after HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials.
abstract: The impact of peripheral blood stem cell transplantation (PBSCT) on survival relative to bone marrow transplantation (BMT) remains poorly defined. Several randomized controlled trials (RCTs) comparing HLA-matched related PBSC- and BMT for patients with hematologic malignancies have been published, yielding differing results. We conducted a meta-analysis of published RCTs to more precisely estimate the effect of PBSCT on survival. Seven trials that assessed survival were identified and included in our analysis. Using a fixed effects model, and combining the results of all seven trials, the summary odds ratio for mortality after PBSCT was 0.81 (95% CI, 0.62-1.05) when compared to BMT. Subgroup analysis revealed no association between the median PBSCT 34+ cell dose and relative risk for morality after PBSCT. However, there was an association between the proportion of patients enrolled with advanced-stage disease and the summary odds ratio for mortality. The pooled estimate was 0.64 for studies where patients with intermediate/advanced disease comprised at least 25% of enrollment, and was 1.07 for the studies enrolling a smaller proportion. This finding substantiates results from previously published studies that have demonstrated a survival advantage with PBSCT limited to patients with advanced disease.
authors.affiliation: Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: J T
authors.initials: JT
authors.lastname: Horan
authors.forename: J L
authors.initials: JL
authors.lastname: Liesveld
authors.forename: I D
authors.initials: ID
authors.lastname: Fernandez
authors.forename: G H
authors.initials: GH
authors.lastname: Lyman
authors.forename: G L
authors.initials: GL
authors.lastname: Phillips
authors.forename: N B
authors.initials: NB
authors.lastname: Lerner
authors.forename: S G
authors.initials: SG
authors.lastname: Fisher
mesh_terms: D000328:Adult; D018952:Antigens, CD34; D016026:Bone Marrow Transplantation / Q000401:mortality*; D002452:Cell Count; D018450:Disease Progression; D005260:Female; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D006648:Histocompatibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D036102:Peripheral Blood Stem Cell Transplantation / Q000401:mortality*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D018952:Antigens, CD34; D006680:HLA Antigens