Long-term outcomes after transplantation of HLA-identical related G-CSF-mobilized peripheral blood mononuclear cells versus bone marrow.
Between 1996 and 1999, 172 patients (median age, 42 years) with hematologic malignancies were randomly assigned to receive either HLA-identical related bone marrow or G-CSF-mobilized peripheral blood mononuclear cells (G-PBMCs) after myeloablative conditioning. Early results showed that transplantation of G-PBMCs, compared with marrow, was associated with significantly superior 2-year disease-free survival (DFS) and overall survival. Ten-year follow-up showed a sustained DFS benefit associated with G-PBMCs (mortality or relapse hazard ratio, 0.64; 95% confidence interval, 0.4-1.0; P = .03), although the likelihood of overall survival was not significantly different between the 2 groups (mortality hazard ratio, 0.75; 95% confidence interval, 0.5-1.2; P = .20). The 10-year cumulative incidence of chronic GVHD and the duration of systemic immunosuppression were similar in the 2 groups. In summary, transplantation of HLA-identical related G-PBMCs, compared with marrow, was associated with superior short-term and long-term DFS, and there was no evidence that this benefit was outweighed by GVHD-related late mortality.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA. mmielcar@fhcrc.org
Marco
M
Mielcarek
Barry
B
Storer
Paul J
PJ
Martin
Stephen J
SJ
Forman
Robert S
RS
Negrin
Mary E
ME
Flowers
Yoshihiro
Y
Inamoto
Thomas R
TR
Chauncey
Rainer
R
Storb
Frederick R
FR
Appelbaum
William I
WI
Bensinger
D000293:Adolescent; D000328:Adult; D001853:Bone Marrow / Q000276:immunology; D002648:Child; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology / Q000401:mortality* / Q000517:prevention & control; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage*; D019337:Hematologic Neoplasms / Q000276:immunology / Q000401:mortality* / Q000628:therapy*; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007963:Leukocytes, Mononuclear; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D015996:Survival Rate; D014185:Transplantation, Isogeneic; D055815:Young Adult
D016179:Granulocyte Colony-Stimulating Factor