Long-term survival after transplantation of unrelated donor peripheral blood or bone marrow hematopoietic cells for hematologic malignancy

Biol Blood Marrow Transplant. 2015 Jan;21(1):55-9. doi: 10.1016/j.bbmt.2014.09.006. Epub 2014 Sep 22.

Abstract

We sought to determine whether differences in chronic graft-versus-host disease (GVHD) rates would lead to survival differences by comparing 2463 peripheral blood (PB) and 1713 bone marrow (BM) hematopoietic cell transplant recipients. Patients had acute leukemia, chronic myeloid leukemia (CML), or myelodysplastic syndrome, and they received myeloablative conditioning regimens and calcineurin-inhibitor GVHD prophylaxis. There were no significant differences in long-term survival after transplantation of PB and BM, except for patients in first chronic phase CML. For these patients, the 5-year rate of survival was lower after transplantation of PB compared with transplantation of BM (35% versus 56%, P = .001). Although mortality risks were higher in patients with chronic GVHD after both PB (hazard ratio [HR], 1.58; P < .001) and BM (HR 1.73; P < .001) transplantations, its effect on mortality did not differ by graft type (P = .42). BM is the preferred graft for first chronic phase CML, whereas as either graft is suitable for other leukemias.

Keywords: Chronic graft-versus-host disease; Leukemia; Mortality.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bone Marrow Transplantation*
  • Calcineurin Inhibitors / therapeutic use
  • Chronic Disease
  • Female
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / mortality*
  • Graft vs Host Disease / pathology
  • Graft vs Host Disease / therapy
  • Humans
  • Leukemia, Biphenotypic, Acute / immunology
  • Leukemia, Biphenotypic, Acute / mortality*
  • Leukemia, Biphenotypic, Acute / pathology
  • Leukemia, Biphenotypic, Acute / therapy
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / immunology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / mortality*
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / pathology
  • Leukemia, Myelogenous, Chronic, BCR-ABL Positive / therapy
  • Male
  • Middle Aged
  • Myeloablative Agonists / therapeutic use
  • Myelodysplastic Syndromes / immunology
  • Myelodysplastic Syndromes / mortality*
  • Myelodysplastic Syndromes / pathology
  • Myelodysplastic Syndromes / therapy
  • Peripheral Blood Stem Cell Transplantation*
  • Survival Analysis
  • Time Factors
  • Transplantation Conditioning*
  • Transplantation, Homologous
  • Unrelated Donors

Substances

  • Calcineurin Inhibitors
  • Myeloablative Agonists