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Multicenter Study
. 2015 Feb 1;33(4):364-9.
doi: 10.1200/JCO.2014.57.2446. Epub 2014 Dec 22.

Bone marrow or peripheral blood for reduced-intensity conditioning unrelated donor transplantation

Mary Eapen  1 , Brent R Logan  2 , Mary M Horowitz  2 , Xiaobo Zhong  2 , Miguel-Angel Perales  2 , Stephanie J Lee  2 , Vanderson Rocha  2 , Robert J Soiffer  2 , Richard E Champlin  2
Affiliations
Multicenter Study

Bone marrow or peripheral blood for reduced-intensity conditioning unrelated donor transplantation

Mary Eapen et al. J Clin Oncol. .

Abstract

Purpose: There have been no randomized trials that have compared peripheral blood (PB) with bone marrow (BM) grafts in the setting of reduced-intensity conditioning (RIC) transplantations for hematologic malignancy. Because immune modulation plays a significant role in sustaining clinical remission after RIC, we hypothesize that higher graft-versus-host disease (GVHD) associated with PB transplantation may offer a survival advantage.

Patients and methods: The primary outcome evaluated was overall survival. Cox regression models were built to study outcomes after transplantation of PB (n = 887) relative to BM (n = 219) for patients with acute myeloid leukemia, myelodysplastic syndrome, or non-Hodgkin lymphoma, the three most common indications for unrelated RIC transplantation. Transplantations were performed in the United States between 2000 and 2008. Conditioning regimens consisted of an alkylating agent and fludarabine, and GVHD prophylaxis involved a calcineurin inhibitor (CNI) with either methotrexate (MTX) or mycophenolate mofetil (MMF).

Results: After adjusting for age, performance score, donor-recipient HLA-match, disease, and disease status at transplantation (factors associated with overall survival), there were no significant differences in 5-year rates of survival after transplantation of PB compared with BM: 34% versus 38% with CNI-MTX and 27% versus 20% with CNI-MMF GVHD prophylaxis.

Conclusion: Survival after transplantation of PB and BM are comparable in the setting of nonirradiation RIC regimens for hematologic malignancy. The effect of GVHD prophylaxis on survival merits further evaluation.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest are found in the article online at www.jco.org. Author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Overall survival by graft type and graft-versus-host disease (GVHD) prophylaxis adjusted for age, performance score, disease and disease status, and donor-recipient HLA-match. The 5-year adjusted probabilities of overall survival after transplantation of bone marrow (BM; 38% [95% CI, 31% to 46%]) and peripheral blood (PB; 34% [95% CI, 29% to 38%]) with calcineurin inhibitor-methotrexate (CNI-MTX) GVHD prophylaxis. The corresponding probabilities with CNI-mycophenolate mofetil (MMF) GVHD prophylaxis were 20% (95% CI, 11% to 29%) and 27% (95% CI, 23% to 31%), respectively.
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References

    1. Anasetti C, Logan BR, Lee SJ, et al. Peripheral-blood cells versus bone marrow from unrelated donors. N Engl J Med. 2012;367:1487–1496. - PMC - PubMed
    1. Nagler A, Labopin M, Shimoni A, et al. Mobilized peripheral blood stem cells compared with bone marrow as the stem cell source for unrelated donor allogeneic transplantation with reduced-intensity conditioning in patients with acute myeloid leukemia in complete remission: An analysis from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2012;18:1422–1429. - PubMed
    1. Flowers ME, Parker PM, Johnston LJ, et al. Comparison of chronic graft-versus-host disease after transplantation of peripheral blood stem cells versus bone marrow in allogeneic recipients: Long-term follow-up of a randomized trial. Blood. 2002;100:415–419. - PubMed
    1. Mohty M, Kuentz M, Michallet M, et al. Chronic graft-versus-host disease after allogeneic blood stem cell transplantation: Long-term results of a randomized study. Blood. 2002;100:3128–3134. - PubMed
    1. Schmitz N, Eapen M, Horowitz MM, et al. Long-term outcome of patients given transplants of mobilized blood or bone marrow: A report from the International Bone Marrow Transplant Registry and the European Group for Blood and Marrow Transplantation. Blood. 2006;108:4288–4290. - PMC - PubMed

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