Long-term outcomes after transplantation of HLA-identical related G-CSF-mobilized peripheral blood mononuclear cells versus bone marrow

Abstract

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.

Figure 1

Long-term outcomes after transplantation of G-PBMCs (n = 81) or bone marrow (n = 91) from HLA-identical siblings after myeloablative conditioning. Kaplan-Meier estimates of OS among all patients (A), and among those with high-risk malignancies (B) and standard-risk malignancies (C); DFS among all patients (D), and among those with high-risk malignancies (E) and standard-risk malignancies (F). (G) OS and (J) DFS after exclusion of 47 patients transplanted for CML in chronic phase. Also shown are cumulative incidence curves of NRM (H), relapse (I), extensive chronic GVHD (K), and discontinuation of all immunosuppressive treatment (L; lower 2 curves). The competing risks of relapse and death are shown in the upper 2 curves. Also shown are the adjusted HRs for respective outcomes using marrow recipients as the reference group. Solid line indicates G-PBMC group; and hyphenated line, bone marrow group.