Faculty Collaboration Database

Peripheral Blood versus Bone Marrow from Unrelated Donors: Bone Marrow Allografts Have Improved Long-Term Overall and Graft-versus-Host Disease-Free, Relapse-Free Survival. Biol Blood Marrow Transplant 2019 Feb;25(2):270-278

Date

10/07/2018

Pubmed ID

30292009

Pubmed Central ID

PMC6339839

DOI

10.1016/j.bbmt.2018.09.004

Scopus ID

2-s2.0-85058163262 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

Peripheral blood (PB) and bone marrow (BM) from unrelated donors can serve as a graft source for hematopoietic cell transplantation (HCT). Currently, PB is most commonly used in roughly 80% of adult recipients. Determining the long-term impact of graft source on outcomes would inform this decision. Data collected by the Center for International Blood and Marrow Transplant Research from 5200 adult recipients of a first HCT from an 8/8 or 7/8 HLA antigen-matched unrelated donor for treatment of acute leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome between 2001 and 2011 were analyzed to determine the impact of graft source on graft-versus-host disease (GVHD) relapse-free survival (GRFS), defined as freedom from grade III/IV acute GVHD, chronic GVHD requiring immunosuppressive therapy, relapse, and death, and overall survival. GRFS at 2 years was superior in BM recipients compared with PB recipients (16%; 95% confidence interval [CI], 14% to 18% versus 10%; 95% CI, 8% to 11%; P <.0001) in the 8/8 HLA-matched cohort and 7/8 HLA-matched cohort (11%; 95% CI, 8% to 14% versus 5%; 95% CI, 4% to 7%; P = .001). With 8/8 HLA-matched unrelated donors, overall survival at 5 years was superior in recipients of BM (43%; 95% CI, 40% to 46% versus 38%; 95% CI, 36% to 40%; P = .014). The inferior 5-year survival in the PB cohort was attributable to a higher frequency of deaths while in remission compared with the BM cohort. For recipients of 7/8 HLA-matched grafts, survival at 5 years was similar in BM recipients and PB recipients (32% versus 29%; P = .329). BM grafts are associated with improved long-term GRFS and overall survival in recipients of matched unrelated donor HCT and should be considered the unrelated allograft of choice, when available, for adults with acute leukemia, chronic myelogenous leukemia, and myelodysplastic syndrome.

Author List

Alousi A, Wang T, Hemmer MT, Spellman SR, Arora M, Couriel DR, Pidala J, Anderlini P, Boyiadzis M, Bredeson CN, Cahn JY, Cairo MS, Gadalla SM, Hashmi SK, Gale RP, Kanda J, Kamble RT, Kharfan-Dabaja MA, Litzow MR, Ringden O, Saad AA, Schultz KR, Verdonck LF, Waller EK, Yared JA, Holtan SG, Weisdorf DJ

Author

Tao Wang PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Allografts
Bone Marrow Transplantation
Disease-Free Survival
Female
Graft vs Host Disease
Hematologic Neoplasms
Humans
Male
Middle Aged
Peripheral Blood Stem Cell Transplantation
Survival Rate
Unrelated Donors