title: Improved graft-versus-host disease-free, relapse-free survival associated with bone marrow as the stem cell source in adults.
abstract: We previously reported that bone marrow grafts from matched sibling donors resulted in best graft-versus-host disease-free, relapse-free survival at 1-year post allogeneic hematopoietic cell transplantation. However, pediatric patients comprised the majority of bone marrow graft recipients in that study. To better define this outcome in adults and pediatric patients at 1- and 2-years post- allogeneic hematopoietic cell transplantation, we pooled data from the University of Minnesota and the Hôpital Saint-Louis in Paris, France (n=1901). Graft-versus-host disease-free, relapse-free survival was defined as the absence of grade III-IV acute graft-versus-host disease, chronic graft-versus-host disease (requiring systemic therapy or extensive stage), relapse and death. In adults, bone marrow from matched sibling donors (n=123) had best graft-versus-host disease-free, relapse-free survival at 1- and 2-years, compared with peripheral blood stem cell from matched sibling donors (n=540) or other graft/donor types. In multivariate analysis, peripheral blood stem cells from matched sibling donors resulted in a 50% increased risk of events contributing to graft-versus-host disease-free, relapse-free survival at 1- and 2-years than bone marrow from matched sibling donors. With limited numbers of peripheral blood stem cell grafts in pediatric patients (n=12), graft-versus-host disease-free, relapse-free survival did not differ between bone marrow and peripheral blood stem cell graft from any donor. While not all patients have a matched sibling donor, graft-versus-host disease-free, relapse-free survival may be improved by the preferential use of bone marrow for adults with malignant diseases. Alternatively, novel graft-versus-host disease prophylaxis regimens are needed to substantially impact graft-versus-host disease-free, relapse-free survival with the use of peripheral blood stem cell.
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA rsmehta@umn.edu.
authors.forename: Rohtesh S
authors.initials: RS
authors.lastname: Mehta
authors.affiliation: Haematology, Hôpital Saint-Louis, Paris, France.
authors.forename: Regis
authors.initials: R
authors.lastname: Peffault de Latour
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Todd E
authors.initials: TE
authors.lastname: DeFor
authors.affiliation: Haematology, Hôpital Saint-Louis, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Lazaryan
authors.affiliation: Haematology, Hôpital Saint-Louis, Paris, France.
authors.forename: Aliénor
authors.initials: A
authors.lastname: Xhaard
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Nelli
authors.initials: N
authors.lastname: Bejanyan
authors.affiliation: Haematology, Hôpital Saint-Louis, Paris, France.
authors.forename: Flore Sicre
authors.initials: FS
authors.lastname: de Fontbrune
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Claudio G
authors.initials: CG
authors.lastname: Brunstein
authors.affiliation: Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Blazar
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: MacMillan
authors.affiliation: Haematology, Hôpital Saint-Louis, Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Socie
authors.affiliation: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Shernan G
authors.initials: SG
authors.lastname: Holtan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D006402:Hematologic Diseases / Q000150:complications / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D006412:Hematopoietic Stem Cells; D006801:Humans; D015994:Incidence; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D014184:Transplantation, Homologous; D055815:Young Adult