title: Filgrastim-mobilized peripheral blood progenitor cells versus bone marrow transplantation for treating leukemia: 3-year results from the EBMT randomized trial.
abstract: OBJECTIVE
  Allogeneic peripheral blood progenitor cells (PBPC) are now widely used as the source of hematopoietic stem cells for transplantation. However, it is still not clear which patients should receive mobilized PBPC or bone marrow cells to reconstitute hematopoiesis after myeloablative conditioning. The aim of this study is to present 3-year-follow-up data on outcome (incidence and severity of chronic graft-versus-host disease (GVHD), overall survival (OS) and leukemia-free survival (LFS) after a PBPC transplant (PBPCT) or a bone marrow transplant (BMT).
  
  
  METHODS
  Data on 350 patients with leukemia were collected in a multicenter, randomized study initiated by the EBMT. The patients were randomized to receive filgrastim-mobilized PBSCT or BMT from an HLA-identical donor.
  
  
  RESULTS
  At a median follow-up of 3 years, significantly more patients transplanted with PBPC than with bone marrow developed chronic GVHD (73% vs 55%, p=0.003) and extensive chronic GvHD (36% vs 19%, p=0.002). The higher incidence and greater severity of chronic GvHD had little impact on the patient's performance status or survival. OS was 58% for PBPCT recipients versus 65% among those undergoing BMT. LFS was 56% for PBPCT recipients versus 60% for BMT recipients.
  
  
  CONCLUSIONS
  Patients transplanted with PBPC from an HLA-identical sibling develop more chronic GvHD than those transplanted with bone marrow, but the final impact of this difference is unclear. Longer follow-up is necessary to characterize the impact of chronic GvHD on quality of life, leukemia-free survival and overall survival.
authors.affiliation: Department of Hematology, AK St Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany. norbert.schmitz@ak-stgeorg.lbk-hh.de
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Meral
authors.initials: M
authors.lastname: Beksac
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Tapani
authors.initials: T
authors.lastname: Ruutu
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
authors.forename: Eliane
authors.initials: E
authors.lastname: Gluckman
authors.forename: Nigel
authors.initials: N
authors.lastname: Russell
authors.forename: Jane
authors.initials: J
authors.lastname: Apperley
authors.forename: Jeff
authors.initials: J
authors.lastname: Szerm
authors.forename: Kenneth
authors.initials: K
authors.lastname: Bradstock
authors.forename: Agnes
authors.initials: A
authors.lastname: Buzyn
authors.forename: Brigitte
authors.initials: B
authors.lastname: Schlegelberger
authors.forename: James
authors.initials: J
authors.lastname: Matcham
authors.forename: Alois
authors.initials: A
authors.lastname: Gratwohl
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D000069585:Filgrastim; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology*; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006648:Histocompatibility; D006801:Humans; D007938:Leukemia / Q000601:surgery*; D015993:Life Tables; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000601:surgery; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011994:Recombinant Proteins; D035781:Siblings; D016019:Survival Analysis
chemical_list: D011994:Recombinant Proteins; D016179:Granulocyte Colony-Stimulating Factor; D000069585:Filgrastim