Fast track — ArticlesLong-term outcome and late effects in patients transplanted with mobilised blood or bone marrow: a randomised trial
Introduction
In 2008, most allogeneic stem cell transplantations used granulocyte-colony-stimulating factor (GCSF)-mobilised peripheral blood as the source of haematopoietic stem cells (HSC).1 Compared with bone marrow, peripheral blood results in faster haematopoietic recovery, but the relative effect of both sources of HSCs on other endpoints of allogeneic stem-cell transplantations, including acute and chronic graft-versus-host disease (GvHD), relapse rates, leukaemia-free survival, and overall survival remain controversial.2 Short-term results of randomised studies have been reported,3, 4, 5, 6, 7, 8 and two meta-analyses comparing peripheral blood with bone marrow grafts have been published.9, 10 Cutler and colleagues9 found that acute and chronic GvHD were more common after peripheral blood stem cell transplantation (PBSCT) than bone-marrow transplantation (BMT), and that PBSCT was associated with a trend toward lower rates of malignant relapse. One of the major findings of the recent meta-analysis by the Stem Cell Trialists' Collaborative Group10 was that PBSCT was associated with a decreased relapse rate in haematological malignancies, and improved survival in patients with late-stage disease and a significant risk of extensive chronic GvHD.10 The follow-up reports of these trials focused on chronic GvHD; however, the median follow-up of 41 months,11 45 months,12 and 36 months13 was still relatively short.
We aimed to collect information on the long-term outcome of patients treated in, to our knowledge, the largest randomised trial to compare peripheral blood with bone marrow grafts. We paid particular attention to chronic GvHD and late effects, including secondary malignancies.
Section snippets
Patients
This was a multicentre, prospective, randomised trial initiated by the European Group for Blood and Marrow Transplantation.8 Patients aged 18–55 years were eligible if diagnosed with de-novo acute myeloid leukaemia (AML) or acute lymphoblastic leukaemia (ALL) in first or second remission, chronic myeloid leukaemia (CML) in first chronic or accelerated phase, or myelodysplastic syndrome (MDS). Patient accrual took place between February, 1995, and September, 1999. The study was approved by the
Results
350 patients from 42 transplantation centres (webappendix) in 13 European countries, Israel, and Australia were randomly assigned to receive either peripheral blood or bone marrow from their HLA-identical sibling donor. 329 patients were eligible for transplantation (figure 1). Completed questionnaires collected at a median of 9·3 years (range 3·0–12·1) after transplantation were available for 176 patients; 87% of all patients reported to be alive 3 years or more after transplantation (92 [52%]
Discussion
This study reports long-term follow-up data of patients treated within the largest randomised study comparing allogeneic PBPCT with BMT. Earlier studies with median follow-up of 3–4 years had repeatedly shown that patients transplanted with peripheral blood experienced more severe chronic GvHD more often than patients who underwent BMT.9, 10, 11, 14 Furthermore, the study by Flowers and colleagues11 indicated that patients who underwent PBPCT experienced protracted courses of GvHD and needed
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