Comparison of Outcomes after Transplantation of G-CSF-Stimulated Bone Marrow Grafts versus Bone Marrow or Peripheral Blood Grafts from HLA-Matched Sibling Donors for Patients with Severe Aplastic Anemia

TY - JOUR

T1 - Comparison of Outcomes after Transplantation of G-CSF-Stimulated Bone Marrow Grafts versus Bone Marrow or Peripheral Blood Grafts from HLA-Matched Sibling Donors for Patients with Severe Aplastic Anemia

AU - Chu, Roland

AU - Brazauskas, Ruta

AU - Kan, Fangyu

AU - Bashey, Asad

AU - Bredeson, Christopher

AU - Camitta, Bruce

AU - Chiang, Kuang-Yueh

AU - Frangoul, Haydar

AU - Gale, Robert Peter

AU - Gee, Adrian

AU - George, Biju

AU - Goldman, Frederick D.

AU - Gross, Thomas G.

AU - Gupta, Vikas

AU - Hale, Gregory A.

AU - Isola, Luis

AU - Urbana Ispizua, Alvaro

AU - Lazarus, Hillard

AU - Marsh, Judith

AU - Russell, James

AU - Sabloff, Mitchell

AU - Waller, Edmund K.

AU - Eapen, Mary

PY - 2011/7

Y1 - 2011/7

N2 - We compared outcomes of patients with severe aplastic anemia (SAA) who received granulocyte-colony stimulating factor (G-CSF)–stimulated bone marrow (G-BM) (n = 78), unstimulated bone marrow (BM) (n = 547), or peripheral blood progenitor cells (PBPC) (n = 134) from an HLA-matched sibling. Transplantations occurred in 1997 to 2003. Rates of neutrophil and platelet recovery were not different among the 3 treatment groups. Grade 2-4 acute graft-versus-host disease (aGVHD) (relative risk [RR] = 0.82, P = .539), grade 3-4 aGVHD (RR = 0.74, P = .535), and chronic GVHD (cGVHD) (RR = 1.56, P = .229) were similar after G-BM and BM transplants. Grade 2-4 aGVHD (RR = 2.37, P = .012) but not grade 3-4 aGVHD (RR = 1.66, P = .323) and cGVHD (RR = 5.09, P < .001) were higher after PBPC transplants compared to G-BM. Grade 2-4 (RR = 2.90, P < .001), grade 3-4 (RR = 2.24, P = .009) aGVHD and cGVHD (RR = 3.26, P < .001) were higher after PBPC transplants compared to BM. Mortality risks were lower after transplantation of BM compared to G-BM (RR = 0.63, P = .05). These data suggest no advantage to using G-BM and the observed higher rates of aGVHD and cGVHD in PBPC recipients warrants cautious use of this graft source for SAA. Taken together, BM is the preferred graft for HLA-matched sibling transplants for SAA.

AB - We compared outcomes of patients with severe aplastic anemia (SAA) who received granulocyte-colony stimulating factor (G-CSF)–stimulated bone marrow (G-BM) (n = 78), unstimulated bone marrow (BM) (n = 547), or peripheral blood progenitor cells (PBPC) (n = 134) from an HLA-matched sibling. Transplantations occurred in 1997 to 2003. Rates of neutrophil and platelet recovery were not different among the 3 treatment groups. Grade 2-4 acute graft-versus-host disease (aGVHD) (relative risk [RR] = 0.82, P = .539), grade 3-4 aGVHD (RR = 0.74, P = .535), and chronic GVHD (cGVHD) (RR = 1.56, P = .229) were similar after G-BM and BM transplants. Grade 2-4 aGVHD (RR = 2.37, P = .012) but not grade 3-4 aGVHD (RR = 1.66, P = .323) and cGVHD (RR = 5.09, P < .001) were higher after PBPC transplants compared to G-BM. Grade 2-4 (RR = 2.90, P < .001), grade 3-4 (RR = 2.24, P = .009) aGVHD and cGVHD (RR = 3.26, P < .001) were higher after PBPC transplants compared to BM. Mortality risks were lower after transplantation of BM compared to G-BM (RR = 0.63, P = .05). These data suggest no advantage to using G-BM and the observed higher rates of aGVHD and cGVHD in PBPC recipients warrants cautious use of this graft source for SAA. Taken together, BM is the preferred graft for HLA-matched sibling transplants for SAA.

KW - G-mobilized BM

KW - GVHD

KW - Aplastic anemia

KW - Survival

KW - VERSUS-HOST-DISEASE

KW - TERM-FOLLOW-UP

KW - STEM-CELLS

KW - PROGENITOR CELLS

KW - HIGH-RISK

KW - RECIPIENTS

KW - MORTALITY

KW - REGISTRY

U2 - 10.1016/j.bbmt.2010.10.029

DO - 10.1016/j.bbmt.2010.10.029

M3 - Article

SN - 1083-8791

VL - 17

SP - 1018

EP - 1024

JO - BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION

JF - BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION

IS - 7

ER -