Patients with acute lymphoblastic leukaemia allografted with a matched unrelated donor may have a lower survival with a peripheral blood stem cell graft compared to bone marrow

Abstract

Summary:We analysed data for 213 patients with ALL and AML who received either peripheral blood stem cells (PBSC) (n ¼ 74) or bone marrow (BM) (n ¼ 139) from an HLAmatched unrelated donor (EBMT acute leukaemia registry; January 1994 to January 1999). The two groups of patients (by cell source) were comparable with respect to age, sex, disease status, year at transplant and graft T cell depletion. Engraftment was achieved in about 90% regardless of stem cell source or leukaemia type. Kinetics of neutrophil and platelet recovery, similar for both sources in ALL patients, were faster for PBSC in AML patients. The incidence of acute graft-versus-host disease was similar for both sources in AML patients, but higher for PBSC in ALL patients (74 vs 54%, P ¼ 0.05). The 1-year probability of chronic graft-versus-host disease was 40 and 45% (P ¼ 0.66) in ALL patients compared to 49 and 35% (P ¼ 0.13) in AML patients (PBSC vs BM). In AML patients, none of the following differed significantly with cell source: transplant-related mortality, relapse incidence, leukaemia-free survival and overall survival. In ALL patients, the transplant-related mortality for PBSC vs BM was 61 vs 47% (P ¼ 0.13), the relapse incidence was 47 vs 39% (P ¼ 0.17), the leukaemia-free survival was 21 vs 32% (P ¼ 0.04) and the overall survival was 24 vs 34% (P ¼ 0.04). These data suggest that the short-term outcome of allogeneic PBSC is not significantly different from that of BM in AML patients who underwent a transplant from a matched unrelated donor but, conversely, that survival with PBSC may be decreased in ALL patients. In conclusion, the source of transplant cells needs to be evaluated by disease, especially when dealing with unrelated donors.

Allo-hematopoietic cell transplantation for Ph chromosome-positive ALL: impact of imatinib on relapse and survival

“…In a retrospective study by Champlin et al 22 through the International Bone Marrow Transplant Registry (IBMTR)/European Bone Marrow Transplant Registry (EBMTR) of 112 adult ALL patients (38 PBSC vs 74 BM), there was no difference in relapse between graft sources, but improved leukemia-free survival (LFS) was shown in CR2 patients receiving PBSC (P ¼ 0.03). This report is contrasted by the Garderet et al 23 analysis through the Acute Leukemia Working Body of the EBMTR, which reported a trend toward greater relapse in 102 ALL patients receiving PBSC (n ¼ 36) than BM (n ¼ 66) (47 vs 39%, P ¼ 0.17) and lower LFS/OS in the PBSC group (P ¼ 0.04). Although there was no significant difference in relapse in either of these analyses between PBSC and BM, and contrasting results regarding LFS, it remains unclear whether PBSC alter the relapse risk or LFS, when compared with BM in ALL.…”

Unrelated donor or partially matched related donor peripheral stem cell transplant with CD34+ selection and CD3+ addback for pediatric patients with leukemias

“…23 In another non-randomized study of patients with acute leukemias, lower survival was noted in ALL patients with PSCs compared with bone marrow. 24 Unlike other studies, the incidence of acute GVHD was higher in ALL patients who received PSCs.…”

Comparing morbidity and mortality of HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative and myeloablative conditioning: influence of pretransplantation comorbidities

“…by guest www.bloodjournal.org From nonablative than ablative patients received G-PBMCs, previous studies have failed to show consistent differences in outcome between unrelated G-PBMCs and marrow grafts. [31][32][33][34][35] Despite higher frequencies of adverse risk factors, nonablative patients experienced significantly less posttransplantation grade IV toxicity as assessed by NCI-CTC. Individual toxicities for which differences were seen included hematologic, hemorrhagic, infectious, gastrointestinal, hepatic, metabolic, and grades III to IV acute GVHD events.…”