Peripheral blood or bone marrow cells in reduced-intensity or myeloablative conditioning allogeneic HLA identical sibling donor transplantation for multiple myeloma.
OBJECTIVE
Peripheral blood stem cells (PBSC) following reduced intensity conditioning (RIC) are being increasingly used for allogeneic transplantation in multiple myeloma. The purpose of this study was to compare outcome of patients transplanted with either PBSC or bone marrow (BM) following RIC or myeloablative conditioning (MAC).


METHODS
Data from 1,667 patients who had received an allogeneic identical sibling donor transplant for multiple myeloma from 1994 to 2003 were analyzed. Comparisons were made between results of PBSC and BM transplants after conditioning with RIC or MAC.


RESULTS
The engraftment rate was faster with PBSC than with BM (median: 14 and 18 days for neutrophils and 15 and 25 days for platelets respectively) irrespectively of whether RIC or MAC was used. The incidence of acute graft-versus-host disease (GVHD) did not differ significantly between the groups while chronic GVHD was more prevalent in PBSC recipients irrespectively of whether they had RIC or MAC. Non-relapse mortality did not differ between PBSC and BM recipients, but was significantly higher in those treated with MAC than in those given RIC irrespectively of the cell source. The relapse/progression rate did not differ between PBSC and BM recipients, but was significantly higher in those given RIC, irrespectively of the cell source. There was no significant difference in overall or progression-free survival between patients given PBSC or BM transplants.


CONCLUSIONS
Although transplantation of PBSC is associated with faster engraftment and more frequent chronic GVHD, overall survival, non-relapse mortality, relapse/progression and progression-free survival are similar to those following BM transplants. However both PBSC and BM transplants are associated with lower non-relapse mortality, lower response rate and higher relapse/progression if RIC is used instead of MAC.
Gahrton
Gösta
G
Department of Medicine, Karolinska institutet, Karolinska University Hospital, Huddinge, SE 14186 Stockholm, Sweden. gosta.gahrton@ki.se
Iacobelli
Simona
S
Bandini
Giuseppe
G
Björkstrand
Bo
B
Corradini
Paolo
P
Crawley
Charles
C
Hegenbart
Ute
U
Morgan
Gareth
G
Kröger
Nicolaus
N
Schattenberg
Anton
A
Schönland
Stefan O
SO
Verdonck
Leo F
LF
Volin
Lisa
L
de Witte
Theo
T
Niederwieser
Dietger
D
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000379:methods* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D035781:Siblings; D014019:Tissue Donors; D014184:Transplantation, Homologous; D016896:Treatment Outcome