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Prepublished online as a Blood First Edition Paper on April 17, 2002; DOI 10.1182/blood-2002-01-0011.
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Blood, 15 July 2002, Vol. 100, No. 2, pp. 415-419
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
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
Mary E. D. Flowers,
Pablo M. Parker,
Laura J. Johnston,
Alice V. B. Matos,
Barry Storer,
William I. Bensinger,
Rainer Storb,
Frederick R. Appelbaum,
Stephen J. Forman,
Karl G. Blume, and
Paul
J. Martin
From the Division of Clinical Research, Fred Hutchinson Cancer
Research Center and Department of Medicine, University of Washington,
Seattle; City of Hope Medical Center, Duarte, CA; and Stanford
University Hospital, CA.
In a previous multicenter phase III trial comparing peripheral
blood stem cell transplantation (PBSCT) to bone marrow transplantation (BMT) from HLA-matched related donors, we found no statistically significant difference in the cumulative incidence of clinical extensive chronic graft-versus-host disease (GVHD) in the 2 groups. We
have analyzed the results in more detail to determine whether the
clinical characteristics of chronic GVHD after PBSCT might be distinct
from those that occur after BMT. Clinical extensive chronic GVHD
developed in 39 of 63 recipients of PBSCs and in 32 of 63 BM recipients
who were alive and free of malignancy at day 100 after the
transplantation. No significant differences were found in the time and
type of onset of clinical extensive chronic GVHD or in the frequency of
complications associated with severe morbidity. Involvement of skin and
female genital tract was more frequent in PBSC recipients than in BM
recipients. The cumulative incidence of chronic GVHD at 3 years was
similar in the 2 groups, but the number of successive treatments needed
to control chronic GVHD was higher after PBSCT than after BMT
(P = .03), and the duration of glucocorticoid treatment
was longer after PBSCT compared to BMT (P = .03). These
results suggest that chronic GVHD after PBSCT may be more protracted
and less responsive to current treatment than chronic GVHD after BMT.
Assessment of the overall benefits of PBSCT compared to BMT will
require continued long-term follow up of morbidity associated with
chronic GVHD.
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