title: Peripheral blood stem cell graft compared to bone marrow after reduced intensity conditioning regimens for acute leukemia: a report from the ALWP of the EBMT.
abstract: Increasing numbers of patients are receiving reduced intensity conditioning regimen allogeneic hematopoietic stem cell transplantation. We hypothesized that the use of bone marrow graft might decrease the risk of graft-versus-host disease compared to peripheral blood after reduced intensity conditioning regimens without compromising graft-versus-leukemia effects. Patients who underwent reduced intensity conditioning regimen allogeneic hematopoietic stem cell transplantation from 2000 to 2012 for acute leukemia, and who were reported to the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation were included in the study. Eight hundred and thirty-seven patients receiving bone marrow grafts were compared with 9011 peripheral blood transplant recipients after reduced intensity conditioning regimen. Median follow up of surviving patients was 27 months. Cumulative incidence of engraftment (neutrophil ≥0.5×10(9)/L at day 60) was lower in bone marrow recipients: 88% versus 95% (P<0.0001). Grade II to IV acute graft-versus-host disease was lower in bone marrow recipients: 19% versus 24% for peripheral blood (P=0.005). In multivariate analysis, after adjusting for differences between both groups, overall survival [Hazard Ratio (HR) 0.90; P=0.05] and leukemia-free survival (HR 0.88; P=0.01) were higher in patients transplanted with peripheral blood compared to bone marrow grafts. Furthermore, peripheral blood graft was also associated with decreased risk of relapse (HR 0.78; P=0.0001). There was no significant difference in non-relapse mortality between recipients of bone marrow and peripheral blood grafts, and chronic graft-versus-host disease was significantly higher after peripheral blood grafts (HR 1.38; P<0.0001). Despite the limitation of a retrospective registry-based study, we found that peripheral blood grafts after reduced intensity conditioning regimens had better overall and leukemia-free survival than bone marrow grafts. However, there is an increase in chronic graft-versus-host disease after peripheral blood grafts. Long-term follow up is needed to clarify whether chronic graft-versus-host disease might increase the risk of late morbidity and mortality.
authors.affiliation: Vanderbilt University Medical Center, Nashville, TN, USA Bipin.Savani@Vanderbilt.Edu.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: EBMT Paris Study Office/CEREST-TC, Paris, France Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Département d'Hématologie - Centre de Recherche en Cancérologie de Marseille - Aix-Marseille University, Institut Paoli Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: University Hospital Leipzig, Hematology, Oncology and Hemostaseology Divisions, Germany.
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ciceri
authors.affiliation: Hannover Medical School - Department of Haematology Hemostasis Oncology and Stem Cell Transplantation, Hannover, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.affiliation: Charité Universitätsmedizin Berlin, Campus Virchow Klinikum - Medizinische Klinik m. S. Hämatologie/Onkologie, Berlin, Germany.
authors.forename: Renate
authors.initials: R
authors.lastname: Arnold
authors.affiliation: Saint Petersburg State Medical Pavlov University, Ratsa Gorbacheva Memorial Children's Institute, Hematology and Transplantology, St. Petersburg, Russia.
authors.forename: Boris
authors.initials: B
authors.lastname: Afanasyev
authors.affiliation: CHU Bordeaux - Hôpital Haut-leveque, Pessac, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Vigouroux
authors.affiliation: CHU Bordeaux - Hôpital Haut-leveque, Pessac, France.
authors.forename: Noel
authors.initials: N
authors.lastname: Milpied
authors.affiliation: University of Cologne, Department of Medicine, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hallek
authors.affiliation: ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Cornelissen
authors.affiliation: Department of Haematology, Oncology Helios-Klinikum Berlin-Buch, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Schwerdtfeger
authors.affiliation: EBMT Paris Study Office/CEREST-TC, Paris, France Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Polge
authors.affiliation: Department of Medicine, Division of Hematology, University of Liège, Belgium.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Baron
authors.affiliation: Department of Hematology, Hospital Clinic, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Esteve
authors.affiliation: Department of Hematology, Saint Antoine Hospital, APHP and University UPMS, Paris, France.
authors.forename: Norbert C
authors.initials: NC
authors.lastname: Gorin
authors.affiliation: Klinikum Augsburg, Department of Hematology and Oncology, University of Munich, Augsburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmid
authors.affiliation: Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Giebel
authors.affiliation: EBMT Paris Study Office/CEREST-TC, Paris, France Department of Haematology, Saint Antoine Hospital, Paris, France INSERM UMR 938, Paris, France Université Pierre et Marie Curie, Paris, France.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.affiliation: EBMT Paris Study Office/CEREST-TC, Paris, France Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Arnon
authors.initials: A
authors.lastname: Nagler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000235:genetics / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D012074:Remission Induction; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents