Matched-pair analysis of peripheral blood stem cells compared to marrow for allogeneic transplantation

We performed a case-control analysis of 42 patients with advanced leukemia or MDS comparing peripheral blood stem cell (PBSC) with marrow grafts (BMT) from HLA-matched sibling donors. PBSC were mobilized with G-CSF (7.5 μg/kg/day) and yielded a median of 6.7 x 10⁶ CD34⁺ cells/kg (range, 1.6-15.0) and 2.7 x 10⁸ CD3⁺ cells/kg (range, 1.1-7.1) vs marrow grafts with a median of 2.0 x 10⁸ nucleated cells/kg (range, 1.8-2.2). Recovery was significantly faster after PBSCT compared to BMT, with a median of 17 (range, 12-26) vs 26 (range, 16-36) days, respectively, to neutrophils >0.5 x 10⁹/l (P < 0.01), and 22 (range, 12->60) vs 42 (range, 18->60) days, for platelet recovery (P < 0.01). Transplantation of ≥7 x 10⁶ CD34⁺ cells/kg accelerated recovery to >20 x 10⁹ l platelets; median 17 days (range, 12-19) vs 23 days (range, 17-36) for those receiving <7 x 10⁶/kg (P = 0.01). PBSC and marrow recipients had similar risks of grades II-IV or III-IV acute GVHD or extensive chronic GVHD (all P > 0.3). At 1 year after PBSCT and BMT, the risk of relapse was 41% and 32%, respectively (P = 0.47), and the probability of survival was 46% and 48%, respectively (P = 0.70). HLA-matched sibling PBSCT resulted in faster neutrophil and platelet engraftment compared to BMT, with no subsequent differences in acute or chronic GVHD, relapse or survival. A minimum of 7 x 10⁶ CD34⁺ cells/kg in PBSC grafts may be required for very rapid platelet engraftment.