title: Bone marrow or peripheral blood stem cell transplantation from unrelated donors in adult patients with acute myeloid leukaemia, an Acute Leukaemia Working Party analysis in 2262 patients.
abstract: BACKGROUND
  No survival benefit of using blood stem cells instead of bone marrow (BM) has been shown in matched unrelated donor (MUD) transplantation.
  
  
  METHODS
  In a retrospective registry analysis, we compared the use of blood stem cells (n = 1502) and BM (n = 760) from unrelated donors in patients aged 18-60 years with acute myeloid leukaemia (AML) undergoing myeloablative conditioning between 1997 and 2008. The blood stem cell recipients were older (P < 0.01), had more advanced disease (P < 0.0001) and received less total body irradiation (P < 0.0001) and more antithymocyte globulin (P = 0.01).
  
  
  RESULTS
  Recovery of neutrophils and platelets was faster with blood stem cells (P < 0.0001). The incidence of acute graft-versus-host disease (GVHD) was similar, but there was more chronic GVHD in the blood stem cell group [hazard ratio (HR) = 1.29, P = 0.02]. There were no significant differences in nonrelapse mortality (NRM), relapse incidence and leukaemia-free survival (LFS) between the two groups amongst patients with AML in remission. In patients with advanced leukaemia, NRM was lower (HR = 0.61, P = 0.02) and LFS was prolonged (HR = 0.67, P = 0.002) when blood stem cells were used. At 3 years, LFS for all patients, regardless of remission status, was 41% for both treatment groups. The outcome was not affected after multivariable analysis adjusted for confounders.
  
  
  CONCLUSIONS
  Blood stem cells compared with BM in MUD transplantation for patients with AML in remission resulted in the same rates of LFS. In patients with advanced leukaemia, the blood stem cell group had reduced NRM and improved LFS.
authors.affiliation: Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden. olle.ringden@ki.se
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.forename: M
authors.initials: M
authors.lastname: Labopin
authors.forename: D W
authors.initials: DW
authors.lastname: Beelen
authors.forename: L
authors.initials: L
authors.lastname: Volin
authors.forename: G
authors.initials: G
authors.lastname: Ehninger
authors.forename: J
authors.initials: J
authors.lastname: Finke
authors.forename: H T
authors.initials: HT
authors.lastname: Greinix
authors.forename: S
authors.initials: S
authors.lastname: Kyrcz-Krzemien
authors.forename: D
authors.initials: D
authors.lastname: Bunjes
authors.forename: L
authors.initials: L
authors.lastname: Brinch
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
authors.forename: R
authors.initials: R
authors.lastname: Arnold
authors.forename: M
authors.initials: M
authors.lastname: Mohty
authors.forename: V
authors.initials: V
authors.lastname: Rocha
mesh_terms: D000293:Adolescent; D000328:Adult; D001853:Bone Marrow; D016026:Bone Marrow Transplantation / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D036102:Peripheral Blood Stem Cell Transplantation / Q000379:methods*; D012008:Recurrence; D012189:Retrospective Studies; D013234:Stem Cells; D061349:Unrelated Donors; D055815:Young Adult