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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1739-1745
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
No difference in graft-versus-host disease, relapse,
and survival comparing peripheral stem cells to bone marrow using
unrelated donors
Mats Remberger,
Oolle Ringdén,
Igor-Wolfgang Blau,
Hellmut Ottinger,
Bernhard Kremens,
Micheil G. Kiehl,
Johan Aschan,
Dietrich W. Beelen,
Nadezda Basara,
Gunilla Kumlien,
Axel A. Fauser, and
Volker Runde
From the Centre for Allogeneic Stem Cell
Transplantation and Department of Clinical Immunology, Huddinge
University Hospital, Stockholm, Sweden; Department of Bone Marrow
Transplantation and Department of Paediatric Haematology and Oncology,
University Hospital, Essen, Germany; and the Clinic of Bone Marrow
Transplantation, Haematology and Oncology, Idar-Oberstein, Germany.
The clinical results in 107 patients receiving a peripheral blood
stem cell (PBSC) graft mobilized by granulocyte colony-stimulating factor (G-CSF) from HLA-A, -B, and -DR-compatible unrelated donors were compared to 107 matched controls receiving unrelated bone marrow
(BM) transplants. Engraftment was achieved in 94% of the patients in
both groups. The PBSC graft contained significantly more nucleated
cells, CD34+, CD3+, and CD56+ cells
(P < .001), and resulted in a significantly shorter
time-to-neutrophil (15 versus 19 days) and platelet engraftment (20 versus 27 days), compared to the BM control group
(P < .001). Probabilities of acute graft-versus-host
disease (GVHD) grades II to IV were 35% and 32% (not significant
[NS]) and of chronic GVHD 61% and 76% (NS) in the PBSC and BM
groups, respectively. There was no difference between the 2 groups in
bacteremia, cytomegalovirus reactivation or disease, and fungal
infection. The 3-year transplant-related mortality (TRM) rates were
42% in the PBSC group and 31% in the BM controls
(P = .7) and the survival rates were 46% and 51%, respectively. The probability of relapse was 25% and 31% in both groups (NS), resulting in disease-free survival rates of 43% in the
PBSC group and 46% in the BM controls (NS). In the multivariate analysis, early disease, acute GVHD grade 0 to I, and presence of
chronic GVHD were independent factors associated with a better disease-free survival in this study. PBSC from HLA-compatible unrelated
donors can be used safely as an alternative to BM for stem cell transplantation.
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