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

Alousi, Amin M.; Wang, Tao; Hemmer, Michael; Spellman, Stephen R.; Arora, Mukta; Couriel, Daniel R.; Pidala, Joseph; Anderlini, Paolo; Boyiadzis, Michael; Bredeson, Christopher; Cahn, Jean‐Yves; Cairo, Mitchell S.; Gadalla, Shahinaz M.; Hashmi, Shahrukh K.; Gale, Robert Peter; Kanda, Junya; Kamble, Rammurti T.; Kharfan‐Dabaja, Mohamed A.; Litzow, Mark R.; Ringdén, Olle; Saad, Ayman; Schultz, Kirk R.; Verdonck, Leo F.; Waller, Edmund K.; Yared, Jean A.; Holtan, Shernan G.; Weisdorf, Daniel J.

doi:10.1016/j.bbmt.2018.09.004

Cited by 23 publications

(20 citation statements)

References 24 publications

(27 reference statements)

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“…Despite the risks and benefits of BM over PB have been widely investigated, the effect of the stem cell source on transplant outcomes deserves special consideration. In MUD transplants, BM reduced the risk of chronic GVHD in a randomized study [32] and improved long-term GRFS and overall survival in a large retrospective registry study [33]. In Haplo-SCT, the use of PB resulted in an increased risk of acute GvHD, uncertain impact of chronic GvHD, and decreased risk of relapse in patients with acute leukemia, but not with lymphoma [34,35].…”

Section: Discussionmentioning

confidence: 99%

Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT

et al. 2020

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Background: The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy. Methods: We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n = 215), MUD (n = 235), and Haplo (n = 789) donors registered in the EBMT database between 2010 and 2017. Results: The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II-IV GVHD (HR 1.6; 95% CI 1.1-2.4) and NRM (HR 2.6; 95% CI 1.5-4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8-1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8-1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4-2.6) and chronic GVHD (HR 1.7; 95% CI 1.2-2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5-0.9).

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Section: Discussionmentioning

confidence: 99%

Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT

et al. 2020

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“…Bone marrow grafts have regained importance due to the introduction of haplo-identical BM-post-transplant cyclophosphamide (PTCy)-based regimens [21][22][23][24][25], reflected in steeply increasing BM-PTCy transplantations [4,5]. Data suggesting at least equally good outcomes for haplo-identical first-degree relative PTCy as for MUD transplantation predict a continuing surge of BM harvesting [26]. BM donor blood management has not previously been addressed; guidelines for optimization and standardization of BM collection procedures are lacking.…”

Section: Discussionmentioning

confidence: 99%

Introduction of principles of blood management to healthy donor bone marrow harvesting

et al. 2020

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Background and Objectives Patient blood (more accurately: haemoglobin, Hb) management (PBM) aims to optimize endogenous Hb production and to minimize iatrogenic Hb loss while maintaining patient safety and optimal effectiveness of medical interventions. PBM was adopted as policy for patients by the World Health Organization (WHO), and, all the more, should be applied to healthy donors. Materials and Methods Observational data from 489 bone marrow (BM) donors were retrospectively analysed, and principles of patient blood management were applied to healthy volunteer BM donations. Results and Conclusion We managed to render BM aspiration safe for donors, notably completely avoiding the collection of autologous blood units and blood transfusions through iron management, establishment and curation of high-yield aspiration technique, limitation of collection volume to 1Á5% of donor body weight and development of volume prediction algorithms for the requested cell dose.

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“…It is important to realize that 4 of 5 patients with aGVHD in the URD group had received a transplant with 1 mismatched allele (2 with an HLA-C mismatch and 2 with an HLA-DQB1 mismatch), which may have contributed to the higher incidence of aGVHD [38À40]. Moreover, patients who receive G-CSF-primed BM have a lower incidence of aGVHD and cGVHD compared with those who receive PBSCs [41,42]. In our institution, only G-CSF-primed PBSCs were the source of stem cells in the URD group because the Chinese Marrow Donor Program and Tzu Chi's Bone Marrow Bank provide only G-CSF-primed PBSCs.…”

Section: Discussionmentioning

confidence: 99%

“…In our institution, only G-CSF-primed PBSCs were the source of stem cells in the URD group because the Chinese Marrow Donor Program and Tzu Chi's Bone Marrow Bank provide only G-CSF-primed PBSCs. However, patients in the MSD group received a mixture of G-CSF-primed PBSCs and G-CSF-primed BM as grafts, which is likely associated with the lower incidence of GVHD in that group [11,42].…”

Section: Discussionmentioning

confidence: 99%

Comparable Outcomes of First-Line Hematopoietic Stem Cell Transplantation from Unrelated and Matched Sibling Donors in Adult Patients with Aplastic Anemia: A Retrospective Single-Center Study

Zhang

et al. 2019

Biology of Blood and Marrow Transplantation

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To explore the feasibility of upfront unrelated donor (URD) hematopoietic stem cell transplantation (HSCT) in the treatment of adult aplastic anemia (AA), we conducted a retrospective, single-center study and compared the outcomes of adult patients who underwent first-line URD HSCT or matched sibling donor (MSD) HSCT between August 2012 and June 2018. In all, 23 URD HSCT recipients had an increased cumulative incidence of grade II acute graft-versus-host disease (aGVHD) (21.7% versus 3.4%; P =.007), but similar rates of secondary graft failure (8.7 § 6.0% versus 6.9 § 3.4%; P = .764), chronic GVHD (cGVHD) (18.2% versus 8.8%; P = .285), extensive cGVHD (9.1% versus 3.5%; P = .328), 5-year estimated overall survival (87.0% versus 94.2%; P = .501), and 5-year estimated failurefree survival (82.0% versus 89.3%; P = .404) compared with 58 MSD HSCT recipients treated during the same period. After using propensity score matching to reduce the influence of potential confounders, the 2 groups were well balanced in terms of pretransplantation clinical factors. The median survival time was similar, and no significant differences in the aforementioned outcomes were observed between the 2 groups. Our results suggest that URD HSCT may be an effective and feasible option for first-line therapy in adult AA patients who lack an MSD.

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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

Cited by 23 publications

References 24 publications

Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT

Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT

Introduction of principles of blood management to healthy donor bone marrow harvesting

Comparable Outcomes of First-Line Hematopoietic Stem Cell Transplantation from Unrelated and Matched Sibling Donors in Adult Patients with Aplastic Anemia: A Retrospective Single-Center Study

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