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Blood, 15 February 2002, Vol. 99, No. 4, pp. 1130-1135
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Improved disease-free-survival after transplantation of
peripheral blood stem cells as compared with bone marrow from
HLA-identical unrelated donors in patients with first chronic phase
chronic myeloid leukemia
Ahmet H. Elmaagacli,
Semiha Basoglu,
Rudolf Peceny,
Rudolf Trenschel,
Hellmut Ottinger,
Andre Lollert,
Volker Runde,
Hans Grosse-Wilde,
Dietrich W. Beelen, and
Ulrich W. Schaefer
From the Department of Bone Marrow
Transplantation, Institute of Immunology, University Hospital of
Essen, Germany.
Outcomes after peripheral blood stem cell transplantation
(PBSCT) for chronic phase chronic myeloid leukemia (n = 37)
were compared with outcomes after bone marrow transplantation (BMT) (n = 54) in the HLA-compatible unrelated donor setting. Median follow-up was 17 months after PBSCT and 29 months after BMT. Both neutrophil and platelet recovery were faster after PBSCT
(P < .05). PBSCT was associated with improved immune
reconstitution, with higher peripheral blood naive
(CD4+CD45RA+) and memory
(CD4+ CD45RO+) helper T cells at 3 months and
12 months after transplantation (P < .03). The
cumulative incidence of acute (grades II-IV) and chronic
graft-versus-host disease (GVHD) were similar, but BMT was associated
with a higher cumulative incidence of severe, acute (grade III-IV) GVHD
at 24% as compared with 8% with PBSCT (P < .05).
Molecular relapse, defined by 2 consecutive positive polymerase chain
reaction assays for bcr-abl within a 4-week interval, occurred in 12 of
45 evaluable patients (27%) after BMT and in 4 of 37 (11%) after
PBSCT (not significant). Cytogenetic relapse occurred in 5 of 54 patients after BMT (9%) and in 1 of the 37 (3%) patients after PBSCT
(not significant). Seventeen of the 54 patients died after BMT (31%),
as compared with 2 of 37 patients after PBSCT (5%). Deaths in the BMT
group were associated mainly with infections and severe, acute GVHD.
The estimated probability of transplant-related mortality (TRM) and
disease-free survival at 1000 days after receiving the transplant were
30% and 64% in the BMT group and 5% and 91% in the PBSCT group
(P < .03). Overall survival 1000 days after receiving
the transplant was 66% after BMT and 94% after PBSCT (P < .02). In the multivariate analysis, only acute GVHD
significantly influenced TRM (P < .01).
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