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Prepublished online as a Blood First Edition Paper on May 17, 2002; DOI 10.1182/blood-2002-01-0048.
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Blood, 1 September 2002, Vol. 100, No. 5, pp. 1525-1531
PLENARY PAPER
A randomized multicenter comparison of bone marrow and peripheral
blood in recipients of matched sibling allogeneic transplants for
myeloid malignancies
Stephen Couban,
David R. Simpson,
Michael J. Barnett,
Christopher Bredeson,
Lothar Hubesch,
Kang Howson-Jan,
Tsiporah B. Shore,
Irwin R. Walker,
Peter Browett,
Hans A. Messner,
Tony Panzarella, and
Jeffrey H. Lipton for
the Canadian Bone Marrow Transplant Group
From the Department of Medicine, Dalhousie University
and Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada;
North Shore Hospital, Takapuna, Auckland, New Zealand; Vancouver
Hospital and Health Sciences Centre and British Columbia Cancer Agency,
Vancouver, BC, Canada; Statistical Center of the International Bone
Marrow Transplant Registry, Health Policy Institute, Medical College of
Wisconsin, Milwaukee; Department of Medicine, Ottawa Hospital and
University of Ottawa, ON, Canada; Departments of Medicine and Oncology,
London Health Sciences Centre and London Regional Cancer Centre,
University of Western Ontario, London, ON, Canada; Weill Medical
College of Cornell University, New York Presbyterian Hospital, New
York; Department of Medicine, McMaster University, Hamilton, ON,
Canada; Division of Molecular Medicine, Faculty of Medical and Health
Sciences, University of Auckland, New Zealand; and Departments of
Medical Oncology and Biostatistics, Princess Margaret Hospital and
University of Toronto, ON, Canada.
Cytokine-mobilized peripheral blood is increasingly used instead of
bone marrow as the source of cells for allogeneic transplantation. Although cells lead to faster hematologic recovery, their effects on
graft-versus-host disease, relapse, and survival are less certain. Between January 1996 and February 2000, 228 patients with chronic myeloid leukemia, acute myeloid leukemia, or myelodysplasia were randomized to receive either bone marrow or peripheral blood allografts from HLA-matched siblings. All patients received busulfan and cyclophosphamide as conditioning chemotherapy and cyclosporine and
methotrexate as graft-versus-host disease prophylaxis. We compared the
times to neutrophil and platelet recovery, acute and chronic
graft-versus-host disease, relapse, and overall survival between the
groups. The median times to neutrophil recovery were 19 days and 23 days and the times to platelet recovery were 16 days and 22 days in the
peripheral blood and bone marrow groups, respectively
(P < .0001 for both comparisons). The cumulative incidence of grades II to IV acute graft-versus-host disease 100 days
after transplantation was 44% in both groups (hazard ratio, 0.99; 95%
confidence interval, 0.66-1.49; P > .9), and the
incidence of extensive chronic graft-versus-host disease at 30 months
after transplantation was 40% with peripheral blood and 30%
with bone marrow (hazard ratio, 1.23; 95% confidence interval,
0.78-1.96; P = .37). There was no statistically
significant difference in the probability of relapse of the underlying
disease between the groups. The probabilities of survival at 30 months
after transplantation were 68% and 60% in the peripheral
blood and bone marrow groups, respectively (hazard ratio, 0.62; 95%
confidence interval, 0.39-0.97; P = .04). In patients
with chronic myeloid leukemia, acute myeloid leukemia, and
myelodysplasia undergoing allogeneic transplantation from matched
siblings, the use of peripheral blood instead of bone marrow leads to
faster hematologic recovery, similar risk of graft-versus-host disease,
and improved survival.
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