Improved graft-versus-host disease-free, relapse-free survival associated with bone marrow as the stem cell source in adults.
Rohtesh S Mehta, Regis Peffault de Latour, Todd E DeFor, Marie Robin, Aleksandr Lazaryan, Aliénor Xhaard, Nelli Bejanyan, Flore Sicre de Fontbrune, Mukta Arora, Claudio G Brunstein, Bruce R Blazar, Daniel J Weisdorf, Margaret L MacMillan, Gerard Socie, Shernan G Holtan
Author Information
Rohtesh S Mehta: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA rsmehta@umn.edu.
Regis Peffault de Latour: Haematology, Hôpital Saint-Louis, Paris, France.
Todd E DeFor: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Marie Robin: Haematology, Hôpital Saint-Louis, Paris, France.
Aleksandr Lazaryan: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Aliénor Xhaard: Haematology, Hôpital Saint-Louis, Paris, France.
Nelli Bejanyan: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Flore Sicre de Fontbrune: Haematology, Hôpital Saint-Louis, Paris, France.
Mukta Arora: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Claudio G Brunstein: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Bruce R Blazar: Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
Daniel J Weisdorf: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Margaret L MacMillan: Blood and Marrow Transplant Program, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
Gerard Socie: Haematology, Hôpital Saint-Louis, Paris, France.
Shernan G Holtan: Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
We previously reported that bone marrow grafts from matched sibling donors resulted in best graft-versus-host disease-free, relapse-free survival at 1-year post allogeneic hematopoietic cell transplantation. However, pediatric patients comprised the majority of bone marrow graft recipients in that study. To better define this outcome in adults and pediatric patients at 1- and 2-years post- allogeneic hematopoietic cell transplantation, we pooled data from the University of Minnesota and the Hôpital Saint-Louis in Paris, France (n=1901). Graft-versus-host disease-free, relapse-free survival was defined as the absence of grade III-IV acute graft-versus-host disease, chronic graft-versus-host disease (requiring systemic therapy or extensive stage), relapse and death. In adults, bone marrow from matched sibling donors (n=123) had best graft-versus-host disease-free, relapse-free survival at 1- and 2-years, compared with peripheral blood stem cell from matched sibling donors (n=540) or other graft/donor types. In multivariate analysis, peripheral blood stem cells from matched sibling donors resulted in a 50% increased risk of events contributing to graft-versus-host disease-free, relapse-free survival at 1- and 2-years than bone marrow from matched sibling donors. With limited numbers of peripheral blood stem cell grafts in pediatric patients (n=12), graft-versus-host disease-free, relapse-free survival did not differ between bone marrow and peripheral blood stem cell graft from any donor. While not all patients have a matched sibling donor, graft-versus-host disease-free, relapse-free survival may be improved by the preferential use of bone marrow for adults with malignant diseases. Alternatively, novel graft-versus-host disease prophylaxis regimens are needed to substantially impact graft-versus-host disease-free, relapse-free survival with the use of peripheral blood stem cell.
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