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Bone marrow, peripheral blood transplantation suitable for hematologic malignancies
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Both peripheral blood stem cells and unstimulated bone marrow appropriate for haploidentical transplantation when paired with posttransplant cyclophosphamide, study data showed.
“For HLA-haploidentical transplantation with posttransplant cyclophosphamide, single centers have reported relatively good outcomes using mobilized peripheral blood,” Asad Bashey, MD, PhD, of The Blood and Matter Transplant Program at Northside Hospital Atlanta, and colleagues wrote. “In a recent small, matched-pair comparison, nonablative haploidentical transplants with post-transplant cyclophosphamide with peripheral blood had similar times to engraftment, rates of acute and chronic graft-versus-host disease and but lower relapse compared with bone marrow.
The researchers outcomes of transplantation with peripheral blood compared with bone marrow. Bashey and colleagues reviewed data 681 patients who underwent transplantation with either bone marrow or peripheral blood in the Ubetween 2009 and 2014 (bone marrow, n = 481; peripheral blood, n = 190). The researchers evaluated differences in outcomes using Cox regression models.
Peripheral blood and bone marrow showed similar rates of hematopoietic recovery (28-day neutrophil recovery, 88% vs. 93%; 100-day platelet recovery, 88% vs. 85%). Patients who underwent bone marrow transplantation for grade 2 to grade 4 acute (HR = 0.45; P < .001) and chronic (HR = 0.35; P < .001) graft-versus-host disease compared with those who received peripheral blood transplantation.
The two therapies demonstrated no significant differences in OS (54% for bone marrow vs. 57% for peripheral blood; HR = 0.99). They also showed no difference in risks for non-relapse mortality (HR = 0.92); however, patients who underwent bone marrow transplantation had a higher relapse risk (HR = 1.49; P = .009). Further analyses revealed that the greater relapse risk occurred in patients who had leukemia (HR = 1.73; P = .002) and not lymphoma (HR = 0.87).
The researchers acknowledged that the study was limited because no data on immune reconstitution, and limited data on molecular factors associated with acute myeloid leukemia.
Steven M. Devine, MD, of The Ohio State University Comprehensive Cancer Center, wrote an accompanying editorial.
“We must move on to other pressing issues such as preventing relapse post-bone marrow transplantation, developing novel nontoxic approaches to treat graft-versus-host disease and using what we have learned in patients with cancer to improve the lives of patients with serious and debilitating nonmalignant hematologic conditions. The advent of safe techniques for transplantation of haploidentical bone marrow and peripheral blood has generated better options for our patients, but with that, more questions than answers.” – by Andy Polhamus
Disclosure: Devine reports consult or advisor with Bristol-Myers Squibb, Incyte and Kite Pharma, research funding from Sanofi.
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