Survival after HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials

Horan, JT; Liesveld, JL; Id, Fernandez; Lyman, GH; Gl, Phillips; Lerner, NB; Fisher, S.

doi:10.1038/sj.bmt.1704112

Cited by 25 publications

(14 citation statements)

References 29 publications

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“…We also employed both high-dose stem cell infusion as well as PBSC-derived grafts for our study that may have resulted in better outcomes. [33][34][35][36][37][38] Although in our study, the incidence of aGVHD was low, the incidence of cGVHD remained relatively high, nevertheless, it stayed within the range of historical controls. Furthermore, neither aGVHD nor cGVHD was statistically significantly associated with the CD34 cells doses infused in our study (P40.05).…”

Section: Discussionmentioning

confidence: 73%

Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis

Lai

Schwarzenberger

et al. 2008

Bone Marrow Transplant

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In an effort to reduce the incidence and severity of acute GVHD (aGVHD), we have developed a new prophylaxis regimen combining cyclosporine and MTX with a short 30-day course of low-dose (500 mg per day) mycophenolate mofetil. This regimen was studied prospectively 100 patients undergoing HLA-matched and 1-antigen-mismatched allogeneic peripheral blood SCT from related donors. The cumulative incidence of aGVHD was 16% (grades II-IV (9.5%) and grades III-IV (1%)). The cumulative incidence of chronic GVHD (cGVHD) was 53% with 28% extensive cGVHD. The cumulative incidence of transplant-related mortality at 100 days and 3 years were 6 and 13%. The estimated probabilities of disease-free survival at 3 years in standard-and high-risk patients were 77 and 30%, respectively (Po0.0001). The estimated probabilities of overall survival at 3 years in standard-and high-risk patients were 77 and 37%, respectively (Po0.0001). These data show a substantial decrease in the risk of developing aGVHD without an increase in relapse or any adverse impact on survival in standard-risk patients.

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Section: Discussionmentioning

confidence: 73%

Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis

Lai

Schwarzenberger

et al. 2008

Bone Marrow Transplant

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“…Several randomized studies have shown a survival advantage for patients with advanced leukemia receiving peripheral stem cell as opposed to bone marrow grafts. 19,20 Such a finding, however, has not been observed for patients with 'good-risk' disease. Patients with high-risk AML in first remission are typically placed into the good risk group and therefore the relative value of peripheral stem cells has not yet been addressed.…”

Section: Limitations Of Clinical Trial Datamentioning

confidence: 63%

The role of allogeneic transplantation in high-risk acute myelogenous leukemia

Drobyski

2004

Leukemia

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Patients with high-risk acute myelogenous leukemia (AML) in first remission are at increased risk for disease recurrence and are often considered for allogeneic bone marrow transplantation (BMT) if there is a suitable HLA-identical sibling donor. Analysis of results from randomized clinical trials comparing different treatment strategies for patients with AML (chemotherapy, autologous BMT, and allogeneic BMT) suggests that allogeneic BMT may be a superior treatment modality for patients in the high-risk subgroup. Interpretation of clinical trial results, however, is problematic due to poor compliance with transplant options, absence of studies specifically designed to addresses this question, and ongoing redefinition of the highrisk subgroup. Alternative allogeneic transplant approaches to reduce toxicity from graft-versus-host disease and enhance graft-versus-leukemia reactivity may offer therapeutic promise in this patient population.

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“…[21][22][23] In our material, we found no difference in DFS among patients given PBSC or BM with CML or acute leukemia with early or late disease.…”

Section: Gvhd Prophylaxismentioning

confidence: 85%

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

Remberger

Beelen

Fauser

et al. 2005

Blood

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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)

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Survival after HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials

Cited by 25 publications

References 29 publications

Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis

Combination of CsA, MTX and low-dose, short-course mycophenolate mofetil for GVHD prophylaxis

The role of allogeneic transplantation in high-risk acute myelogenous leukemia

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

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