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Prepublished online as a Blood First Edition Paper on April 30, 2002; DOI 10.1182/blood-2001-12-0304.
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Blood, 1 August 2002, Vol. 100, No. 3, pp. 761-767
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Transplantation of mobilized peripheral blood cells to
HLA-identical siblings with standard-risk leukemia
Norbert Schmitz,
Meral Beksac,
Dirk Hasenclever,
Andrea Bacigalupo,
Tapani Ruutu,
Arnon Nagler,
Eliane Gluckman,
Nigel Russell,
Jane F. Apperley,
Norbert C. Gorin,
Jeff Szer,
Ken Bradstock,
Agnes Buzyn,
Peter Clark,
Keith Borkett, and
Alois Gratwohl for the European Group for
Blood and Marrow Transplantation
From the Department of Internal Medicine II, University
of Kiel, Germany; Department of Hematology/Oncology, Ankara University,
Turkey; Institute of Medical Informatics, Statistics and Epidemiology,
University of Leipzig, Germany; Department of Hematology, Ospedale San
Martino, Genova, Italy; Department of Medicine, Helsinki University
Central Hospital, Finland; Department of Bone Marrow Transplantation,
Hadassah University Hospital, Jerusalem, Israel; Nottingham City
Hospital, United Kingdom; Department of Hematology, Hammersmith
Hospital, London, United Kingdom; Bone Marrow Transplant Service, The
Royal Melbourne Hospital, Parkville, Australia; Blood and Marrow
Transplant Service, Westmead Hospital, Sydney, Australia; Amgen,
Cambridge, United Kingdom; Kantonsspital, Basel, Switzerland; and
Department of Hematology, Hôpital St Louis; Department of
Hematology, Hôpital St Antoine; and Hôpital Necker, Service
d'Hematologie/Adulte; all of Paris, France. Participating institutions
and investigators are listed in the "appendix" at the end of this
article.
Allogeneic mobilized peripheral blood progenitor cells instead of
bone marrow are increasingly used to restore hematopoiesis after
myeloablative therapy. Data supporting this important change of
clinical practice are scarce. We therefore assigned patients with early
leukemias to peripheral blood or bone marrow transplantation; the
occurrence of acute and chronic graft versus host disease, survival,
transplantation-related mortality, and relapse rates were compared. A
total of 350 patients between 18 and 55 years of age with acute
leukemias in remission or chronic myelogenous leukemia in first
chronic phase were randomized to receive either filgrastim-mobilized
peripheral blood progenitor cells or bone marrow cells from
HLA-identical sibling donors after standard high-dose
chemoradiotherapy. Neutrophil and platelet recovery occurred
significantly faster after transplantation of peripheral blood
progenitor cells than after bone marrow transplantation. Acute graft
versus host disease of grades II-IV was significantly more frequent in
recipients of peripheral blood progenitor cells than in recipients of
marrow cells (52% vs 39%, odds ratio 1.74, 95% confidence
interval 1.12-2.69, P = .013). The cumulative incidence of chronic graft versus host disease was 67% with peripheral blood progenitor cells and 54% with bone marrow cells (hazard ratio 1.67, 95% confidence interval 1.15-2.42, P = .0066). The
estimated overall probability of survival at 2 years was 65% with
either source of stem cells (hazard ratio 1.15, 95% confidence
interval 0.79-1.67, P = .46). Disease-free survival,
transplantation-related mortality at day 100, and relapse rates did not
significantly differ between treatment arms. Peripheral blood is an
equivalent source of hematopoietic stem cells compared with bone marrow
if administered to patients with standard-risk leukemias. Long-term observation of patients with different diseases and stages of disease
is necessary to ultimately define the role of both sources of stem cells.
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