Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups

Andrea Bacigalupo; Gerard Socie; Hubert Schrezenmeier; Andre Tichelli; Anna Locasciulli; Monika Fuehrer; Antonio M. Risitano; Carlo Dufour; Jakob R. Passweg; Rosi Oneto; Mahmoud Aljurf; Catherine Flynn; Valerie Mialou; Rose Marie Hamladji; Judith Marsh; European Grp Blood Marrow Transpla

doi:10.3324/haematol.2011.054841

Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups

Andrea Bacigalupo^*, Gerard Socie, Hubert Schrezenmeier, Andre Tichelli, Anna Locasciulli, Monika Fuehrer, Antonio M. Risitano, Carlo Dufour, Jakob R. Passweg, Rosi Oneto, Mahmoud Aljurf, Catherine Flynn, Valerie Mialou, Rose Marie Hamladji, Judith Marsh, European Grp Blood Marrow Transpla

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

188 Citations (Scopus)

Abstract

Background: Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia. Design and Methods: We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells. Results: In multivariate Cox analysis negative predictors for survival were: patient’s age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6,P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1–19 years (90% versus76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%,P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%). Conclusions: This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.

Original language	English
Pages (from-to)	1142-1148
Number of pages	7
Journal	Haematologica
Volume	97
Issue number	8
DOIs	https://doi.org/10.3324/haematol.2011.054841
Publication status	Published - Aug 2012

Keywords

aplastic anemia
allogeneic transplantation
bone marrow transplants
peripheral blood transplants
VERSUS-HOST-DISEASE
ANTITHYMOCYTE GLOBULIN
UNRELATED DONORS
OUTCOMES
PROPHYLAXIS
FLUDARABINE
REGIMEN
TRIAL

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10.3324/haematol.2011.054841

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Bacigalupo, A., Socie, G., Schrezenmeier, H., Tichelli, A., Locasciulli, A., Fuehrer, M., Risitano, A. M., Dufour, C., Passweg, J. R., Oneto, R., Aljurf, M., Flynn, C., Mialou, V., Hamladji, R. M., Marsh, J., & European Grp Blood Marrow Transpla (2012). Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups. Haematologica, 97(8), 1142-1148. https://doi.org/10.3324/haematol.2011.054841

@article{415573dfb8c9431d8b40608c7916fb25,

title = "Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups",

abstract = "Background: Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia. Design and Methods: We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells. Results: In multivariate Cox analysis negative predictors for survival were: patient{\textquoteright}s age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6,P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1–19 years (90% versus76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%,P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%). Conclusions: This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.",

keywords = "aplastic anemia, allogeneic transplantation, bone marrow transplants, peripheral blood transplants, VERSUS-HOST-DISEASE, ANTITHYMOCYTE GLOBULIN, UNRELATED DONORS, OUTCOMES, PROPHYLAXIS, FLUDARABINE, REGIMEN, TRIAL",

author = "Andrea Bacigalupo and Gerard Socie and Hubert Schrezenmeier and Andre Tichelli and Anna Locasciulli and Monika Fuehrer and Risitano, {Antonio M.} and Carlo Dufour and Passweg, {Jakob R.} and Rosi Oneto and Mahmoud Aljurf and Catherine Flynn and Valerie Mialou and Hamladji, {Rose Marie} and Judith Marsh and {European Grp Blood Marrow Transpla}",

year = "2012",

month = aug,

doi = "10.3324/haematol.2011.054841",

language = "English",

volume = "97",

pages = "1142--1148",

journal = "Haematologica",

issn = "0390-6078",

publisher = "Ferrata Storti Foundation",

number = "8",

}

Bacigalupo, A, Socie, G, Schrezenmeier, H, Tichelli, A, Locasciulli, A, Fuehrer, M, Risitano, AM, Dufour, C, Passweg, JR, Oneto, R, Aljurf, M, Flynn, C, Mialou, V, Hamladji, RM, Marsh, J & European Grp Blood Marrow Transpla 2012, 'Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups', Haematologica, vol. 97, no. 8, pp. 1142-1148. https://doi.org/10.3324/haematol.2011.054841

TY - JOUR

T1 - Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia

T2 - survival advantage for bone marrow in all age groups

AU - Bacigalupo, Andrea

AU - Socie, Gerard

AU - Schrezenmeier, Hubert

AU - Tichelli, Andre

AU - Locasciulli, Anna

AU - Fuehrer, Monika

AU - Risitano, Antonio M.

AU - Dufour, Carlo

AU - Passweg, Jakob R.

AU - Oneto, Rosi

AU - Aljurf, Mahmoud

AU - Flynn, Catherine

AU - Mialou, Valerie

AU - Hamladji, Rose Marie

AU - Marsh, Judith

AU - European Grp Blood Marrow Transpla

PY - 2012/8

Y1 - 2012/8

N2 - Background: Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia. Design and Methods: We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells. Results: In multivariate Cox analysis negative predictors for survival were: patient’s age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6,P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1–19 years (90% versus76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%,P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%). Conclusions: This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.

AB - Background: Bone marrow has been shown to be superior to peripheral blood, as a stem cell source, in young patients (<20 years of age) with acquired aplastic anemia undergoing a matched sibling transplant. The aim of this study was to test whether this currently also holds true for older patients with acquired aplastic anemia. Design and Methods: We analyzed 1886 patients with acquired aplastic anemia who received a first transplant from a human leukocyte antigen identical sibling between 1999 and 2009, with either bone marrow (n=1163) or peripheral blood (n=723) as the source of stem cells. Results: In multivariate Cox analysis negative predictors for survival were: patient’s age over 20 years (RR 2.0, P<0.0001), an interval between diagnosis and transplantation of more than 114 days (RR 1.3, P=0.006), no anti-thymocyte globulin in the conditioning (RR 1.6, P=0.0001), a conditioning regimen other than cyclophosphamide (RR=1.3, P=0.008) and the use of peripheral blood as the source of stem cells (RR 1.6,P<0.00001). The survival advantage for recipients of bone marrow rather than peripheral blood was statistically significant in patients aged 1–19 years (90% versus76% P<0.00001) as well as in patients aged over 20 years (74% versus 64%,P=0.001). The advantage for recipients of bone marrow over peripheral blood was maintained above the age of 50 years (69% versus 39%, P=0.01). Acute and chronic graft-versus-host disease were more frequent in peripheral blood transplants. Major causes of death were graft-versus-host disease (2% versus 6% in bone marrow and peripheral blood recipients, respectively), infections (6% versus 13%), and graft rejection (1.5% versus 2.5%). Conclusions: This study shows that bone marrow should be the preferred stem cell source for matched sibling transplants in acquired aplastic anemia, in patients of all age groups.

KW - aplastic anemia

KW - allogeneic transplantation

KW - bone marrow transplants

KW - peripheral blood transplants

KW - VERSUS-HOST-DISEASE

KW - ANTITHYMOCYTE GLOBULIN

KW - UNRELATED DONORS

KW - OUTCOMES

KW - PROPHYLAXIS

KW - FLUDARABINE

KW - REGIMEN

KW - TRIAL

U2 - 10.3324/haematol.2011.054841

DO - 10.3324/haematol.2011.054841

M3 - Article

SN - 0390-6078

VL - 97

SP - 1142

EP - 1148

JO - Haematologica

JF - Haematologica

IS - 8

ER -

Bone marrow versus peripheral blood as the stem cell source for sibling transplants in acquired aplastic anemia: survival advantage for bone marrow in all age groups

Abstract

Keywords

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