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Blood, 1 December 2001, Vol. 98, No. 12, pp. 3186-3191
PLENARY PAPER
Granulocyte-colony-stimulating factor (G-CSF)-primed allogeneic
bone marrow: significantly less graft-versus-host disease and
comparable engraftment to G-CSF-mobilized peripheral blood
stem cells
James Morton,
Cheryl Hutchins, and
Simon Durrant
From the Bone Marrow Transplant Unit, Royal Brisbane
Hospital, Herston, Australia.
Prospective studies have shown rapid engraftment using
granulocyte-colony-stimulating factor-mobilized peripheral blood stem cells (G-PBSCs) for allogeneic transplantation, though the risks for
graft-versus-host disease (GVHD) may be increased. It was hypothesized
that the use of G-CSF to prime bone marrow (G-BM) would allow rapid
engraftment without increased risk for GVHD compared with G-PBSC.
Patients were randomized to receive G-BM or G-PBSCs for allogeneic stem
cell transplantation. The study was designed ( < .8) to
detect a difference in the incidence of chronic GVHD of 33%
( < .05). The plan was to recruit 100 patients and to conduct an
interim analysis when the 6-month follow-up point was reached for the
first 50 patients. Fifty-seven consecutive patients were
recruited (G-BM, n = 28; G-PBSC, n = 29). Patients in the G-PBSC
group received 3-fold more CD34+ and 9-fold more
CD3+ cells. Median times to neutrophil (G-BM, 16 days;
G-PBSC, 14 days; P < .1) and platelet engraftment (G-BM,
14 days; G-PBSC, 12 days; P < .1) were similar. The use
of G-PBSC was associated with steroid refractory acute GVHD (G-BM, 0%;
G-PBSC, 32%; P < .001), chronic GVHD (G-BM, 22%;
G-PBSC, 80%; P < .02), and prolonged requirement for
immunosuppressive therapy (G-BM, 173 days; G-PBSC, 680 days;
P < .009). Survival was similar for the 2 groups.
Compared with G-PBSC, the use of G-BM resulted in comparable
engraftment, reduced severity of acute GVHD, and less subsequent
chronic GVHD.
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