Increased risk of extensive chronic graft-versus-host disease after allogeneic peripheral blood stem cell transplantation using unrelated donors

Abstract

The long-term follow-up of a study including 214 patients receiving either peripheral blood stem cells (PBSCs) or bone marrow (BM) from an HLA-A, -B, and -DR-compatible unrelated donor is presented. Median follow-up was 4.4 (2.3-7.3) and 5.0 (0.7-8.4) years in the 2 groups, respectively. Cumulative incidence of overall chronic graft-versus-host disease (GVHD) was similar in the 2 groups (78% vs 71%), while extensive chronic GVHD was significantly more common in the PBSC group compared with the BM group (39% vs 24%, P ‫؍‬ .03). The 5-year transplant-related mortality (TRM) was 37% in the PBSC group and 35% in the BM controls (P ‫؍‬ .7), and overall survival was 42% in both groups. The relapse incidences were 26% and 27% in the 2 groups, respectively, resulting in a disease-free survival of 41% in both groups. In conclusion, PBSCs from HLA-compatible unrelated donors results in similar outcome compared to BM but implies an increased risk for extensive chronic GVHD. (Blood. 2005;105:548-551)

PBSC vs BM grafts with myeloablative conditioning for unrelated donor transplantation in adults with high-risk ALL

“…Unfortunately, our study was not able to assess the impact of the graft source on transplantation outcomes according to disease status at transplantation, because only a few patients received transplantation beyond CR1. However, in line with other studies, [20][21][22][23][24][25][27][28][29] our data showed nearly identical outcomes in terms of relapse, NRM, DFS and OS between the two graft sources among transplants in CR1. Therefore, further follow-up with a sizable population is required to define the advantages of URD-SCT using PBSC compared with BM in advanced ALL.…”

“…Conversely, except for two studies, 26,28 there was no survival advantage for one graft type over another in the setting of URD-SCT for various hematologic malignancies. [20][21][22][23][24][25]27,29,40 This discrepancy may be attributable to the differences in the sensitivity of underlying disease to graftversus-leukemia effect. According to data from the European Group for Blood and Marrow Transplantation registry, 28 the authors retrospectively compared the use of PBSC (n = 1502) and BM (n = 760) only for AML transplants after myeloablative conditioning transplants URD-SCT.…”

“…However, few studies are available that compare the outcomes of PBSC vs BM transplants in the setting of URD-SCT. [20][21][22][23][24][25][26][27][28][29] Furthermore, an analysis of the long-term outcomes of URD-SCT according to the graft source has not yet been reported in adults with ALL. In order to determine which graft source is superior in adults with high-risk ALL, we compared the long-term outcomes of URD-SCT between PBSC and BM.…”

G-CSF-primed bone marrow as a source of stem cells for allografting: revisiting the concept

“…[19][20][21][22] The relative risk (RR) of developing clinical chronic extensive GvHD by 2 years among patients who had received PBSC grafts as compared with BM grafts in related donors 23 was 2.37 (95% confidence interval: 1.07-5.29, P = 0.035). This was also shown in unrelated donors 24 where extensive chronic GvHD was significantly more common in the PBSC group compared with the BM group (39% vs 24%, P = 0.03).…”

Nephrotic syndrome associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

“…29 Furthermore, extensive cGVHD is more common in the recipients of peripheral blood stem cell transplant. 30,31 Cellular composition of the peripheral stem cell graft, which contained high numbers of Th2 lymphocytes 32 and/or CD14 þ cells 33 might have contributed to the relatively low incidence of acute GVHD but increased the risk of extensive cGVHD. The pathophysiology of cGVHD is poorly understood.…”