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.

Abstract

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).

• Authors: Ahmet H Elmaagacli, Semiha Basoglu, Rudolf Peceny, Rudolf Trenschel, Hellmut Ottinger, Andre Lollert, Volker Runde, Hans Grosse-Wilde, Dietrich W Beelen, Ulrich W Schaefer
• Journal: Blood (Blood) Vol. 99 Issue 4 Pg. 1130-5 (Feb 15 2002) ISSN: 0006-4971 [Print] United States
• PMID: 11830457 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Adult
• Bone Marrow Transplantation (adverse effects, mortality)
• Disease-Free Survival
• Female
• Graft Survival
• Graft vs Host Disease (etiology, mortality)
• Hematopoiesis
• Hematopoietic Stem Cell Transplantation (adverse effects, mortality)
• Histocompatibility Testing
• Humans
• Incidence
• Kinetics
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (mortality, therapy)
• Male
• Middle Aged
• Recurrence
• Retrospective Studies
• Survival Analysis
• Tissue Donors
• Transplantation, Homologous (adverse effects, methods, mortality)
• Treatment Outcome