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Bone marrow, mobilized blood cells yield similar long-term outcomes after transplant

Issue: July 10, 2010

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Long-term follow-up of leukemia patients showed little difference in terms of overall and leukemia-free survival between those patients who received bone marrow transplantation and peripheral blood progenitor cell transplantation.

“Compared with bone marrow, peripheral blood results in faster hematopoietic recovery, but the relative effect of both sources of hematopoietic stem cells on other endpoints of allogeneic stem-cell transplantations, including acute and chronic graft-versus-host disease, relapse rates, leukemia-free survival, and overall survival remain controversial,” researchers wrote.

In this study, the investigators randomly assigned 329 patients to either bone marrow transplantation (BMT) (n=166) or PBPCT (n=163); they followed the patients for a median of 9.3 years.

For peripheral blood progenitor cell transplantation (PBPCT) patients, the 10-year OS was 49.1% compared with 56.5% for BMT patients (P=.27). Leukemia-free survival was also similar, at 13% for PBPCT and 28.3% for BMT (P=.12) in those with acute lymphoblastic leukemia only; in those with acute myeloid leukemia, the rates were 47.1% for BMT vs. 62.3% (P=.16), and in those with chronic myeloid leukemia, they were 48.5% for BMT vs. 40.2% (P=.60).

There were some differences in terms of adverse events between BMT and PBPCT patients. PBPCT resulted in more chronic graft-versus-host disease (73% vs. 56%; P=.021), and PBPCT patients needed more immunosuppressive treatment 5 years after treatment (26% vs. 12%, P=.024).

In an accompanying editorial, Ray Powles, MD, of the Parkside Oncology Clinic in London, noted that these results raise questions around the dominant use of PBPCT in today’s practice. “For instance, it seems that patients with CML obtain real benefit from PBSCT, but with second and third generation targeted therapies producing extraordinary disease-free survival benefit, allografting is now a rarity, and one does not want to end up trying to use BMT for end-stage, older patients,” he wrote. “We need an effective molecular screen at diagnosis to pick the right patients for transplantation.”

For more information:

• Friedrichs B. Lancet Oncol. 2010;11:331-338.