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Blood, 15 June 2002, Vol. 99, No. 12, pp. 4370-4378
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Retrospective comparison of bone marrow and granulocyte
colony-stimulating factor-mobilized peripheral blood progenitor cells
for allogeneic stem cell transplantation using HLA identical sibling
donors in myelodysplastic syndromes
Philippe Guardiola,
Volker Runde,
Andrea Bacigalupo,
Tapani Ruutu,
Franco Locatelli,
Marc A. Boogaerts,
Antonio Pagliuca,
Jan J. Cornelissen,
Harry C. Schouten,
Enric Carreras,
Jürgen Finke,
Anja van Biezen,
Ronald Brand,
Dietger Niederwieser,
Eliane Gluckman, and
Theo M. de Witte for the subcommittee for Myelodysplastic Syndromes of the
Chronic Leukaemia Working Party of the European Blood and Marrow
Transplantation Group
From the Service de Greffe de Moelle, Hôpital
Saint-Louis, Paris, France; Department of Bone Marrow Transplantation,
University Hospital, Essen, Germany; Department of Hematology, Ospedale
San Martino, Genova, Italy; Department of Medicine, Helsinki University
Central Hospital, Finland; Pediatric Department, University of Pavia,
IRCCS Policlinico San Matteo, Italy; Department of Haematology,
University Hospital Gasthuisberg, Leuven, Belgium; Department of
Haematology, King's College Hospital, London, United Kingdom; Daniel
Den Hoed Cancer Center, Rotterdam, The Netherlands; Department of
Hematology/Oncology, University Hospital, Maastricht, The Netherlands;
BMT Unit, Institute of Hematology and Oncology, Hospital Clinic,
Barcelona, Spain; Department of Hematology/Oncology, University of
Freiburg, Germany; Department of Medical Statistics, Leiden University
MC, The Netherlands; Department of Haematology-Oncology, University of
Leipzig, Germany; and Division of Hematology, University Hospital St
Radboud, Nijmegen, The Netherlands.
In this multicenter retrospective study, the outcomes of 234 patients with myelodysplastic syndrome (MDS) who underwent
transplantation between 1995 and 1999 from HLA-identical siblings were
analyzed according to the hematopoietic stem cell source used, that is, bone marrow (BM, n = 132) or granulocyte colony-stimulating
factor-mobilized peripheral blood progenitor cells (PBPCs, n = 102).
There were 69 cases of refractory anemia (RA), 86 RA with excess blasts
(RAEB), 75 RAEB in transformation (RAEB-t), and 4 unclassified MDS at diagnosis. The International Prognostic Scoring System was
intermediate-2 or high in 104 of the 158 available scores. Multivariate
analyses focused on transplantation-related mortality (TRM), 2-year
treatment failure incidence, and survival. Use of PBPCs reduced the
median duration of neutropenia and thrombocytopenia by 4 and 12 days, respectively. The incidence of acute GVHD was similar whatever the
graft type used. Chronic GVHD was more likely to have occurred with
PBPCs (odds ratio [OR], 1.62; 95% confidence interval [CI], 0.87-3.02). Two-year TRM was significantly reduced with PBPCs (relative
risk [RR], 0.33; 95% CI, 0.15-0.73; P < .007), except for patients who had either RA or high-risk cytogenetics. The 2-year
treatment failure incidence was significantly decreased with PBPCs,
from 38% to 13% (RR, 0.22; 95% CI, 0.10-0.48;
P < .001). Estimate of the 2-year event-free survival
was 50% with PBPCs versus 39% with BM. In multivariate analysis, the
outcome was significantly improved with PBPCs (RR, 0.27; 95% CI,
0.13-0.52; P < .001), except for patients with either RA
or high-risk cytogenetics. In conclusion, PBPCs might be preferred for
allogeneic transplantation in MDS patients at high risk for relapse on
the basis of morphologic criteria because the use of this hematopoietic
stem cell was associated with lower treatment failure incidence and
improved survival.
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