Autologous bone marrow versus non-mobilized peripheral blood stem cell transplantation for lymphoid malignancies: A prospective, comparative trial

Autologous transplantation using bone marrow stem cells (BMSC) or peripheral blood stem cells (PBSC) is widely used for non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). We report a randomized, comparative trial comparing BMSC vs. nonmobilized PBSC for responsive NHL or HD. Patients randomized to BMSC (n = 13) vs. PBSC (n = 15) had more rapid neutrophil recovery (median 23 vs. 30 days), RBC independence (25 vs. 62 days), platelet independence (24 vs. 54 days), and shorter hospital stay. However, neither relapse, overall survival, nor relapse-free survival were different receiving BMSC vs. PBSC (all P > .7). Concurrently, 54 others (34 BMSC, 20 PBSC) were assigned non-randomly because of resistant disease or marrow unsuitable for harvest and similar patterns of engraftment favoring BMSC over PBSC were observed. In the entire group, BMSC transplantation (n = 47) led to quicker neutrophil recovery (P = .02), RBC (P = .06), and platelet independence (P = .04) and earlier hospital discharge (P = .02) vs. PBSC (n = 35). No difference in relapse, overall, or relapse-free survival were observed using BMSC vs. PBSC. These data suggest that non-mobilized PBSC are a satisfactory alternative to BMSC in patients with unsuitable marrow; however, transplantation with non-mobilized PBSC was associated with slower hematologic recovery, and longer hospital stay. No difference in tumor recurrence rates was observed between the PBSC or BMSC recipients. Unprimed PBSC transplantation offered no clinical advantage to BMSC.