The role of stem cell source in autologous hematopoietic stem cell transplantation for patients with myelodysplastic syndromes.
OBJECTIVE
Intensive chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) is a curative treatment option for patients with myelodysplastic syndromes (MDS). Peripheral blood (PB) HSCT was introduced in 1992 and PB has become the source of choice of autologous stem cells worldwide. Autologous PB stem cells result in faster hematopoietic recovery, but may be associated with a higher risk of relapse.


METHODS
We analyzed the data of 336 patients transplanted after 1992 with either bone marrow (BM) (n=104) or PB (n=232).


RESULTS
Various factors had an impact on event-free survival in univariate analysis: age hazard ratio [HR]=1.1 per 10 years; p=0.12), source of stem cells (HR=1.2, p=0.22), interval between diagnosis and transplantation (HR=1.0 per month; p=0.87), and therapy-related vs primary disease (HR=0.5; p=0.002). In the multivariate Cox model, the event-free survival was not different after PB or BM HSCT with a HR of 0.93 (95% confidence interval of 0.67 - 1.30; p=0.67). The relapse risk after transplantation with stem cells from either source was similar with a HR of 1.1. A significant interaction (p=0.02) between age and the source of stem cells indicated a more favorable potential of autologous PB HSCT in young age groups.


CONCLUSIONS
Autologous PB and BM HSCT result in equivalent outcomes. Therefore, given the more rapid hematopoietic recovery PB is the preferred source of stem cells.
de Witte
Theo
T
Dept. of Hematology, Radboud University Medical Center Nijmegen, The Netherlands.
Brand
Ronald
R
van Biezen
Anja
A
Delforge
Michel
M
Biersack
Harold
H
Or
Reuven
R
Meloni
Giovanna
G
Bandini
Beppe
B
Sierra
Jorge
J
Kroger
Nicolaus
N
Gratwohl
Alois
A
Niederwieser
Dietger
D
D000704:Analysis of Variance; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006412:Hematopoietic Stem Cells / Q000473:pathology* / Q000502:physiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000097:blood / Q000628:therapy; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000097:blood / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous