Peripheral Blood Grafts from Unrelated Donors Are Associated with Increased Acute and Chronic Graft-versus-Host Disease without Improved Survival

Mary Eapen, Brent R. Logan, Dennis L. Confer, Michael Haagenson, John E. Wagner, Daniel J. Weisdorf, John R. Wingard, Scott D. Rowley, David Stroncek, Adrian P. Gee, Mary M. Horowitz, Claudio Anasetti

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146 Scopus citations

Abstract

Few studies have tested the benefits of using peripheral blood stem cell (PBSC) grafts versus bone marrow (BM) grafts for unrelated donor transplantation. Yet there has been a substantial change in clinical practice, with increasing numbers of adults receiving unrelated donor PBSC grafts. We compared outcomes after 331 PBSC and 586 BM transplants in adults with leukemia and myelodysplastic syndrome (MDS) who were followed for a median of 3 years after transplantation. PBSC recipients were less likely to have chronic myelogenous leukemia (CML) and more likely to have MDS, to have poor performance scores, and to be transplanted more recently. Outcomes were analyzed using Cox regression models. Rates of grades 2-4 acute graft-versus-host disease (GVHD) (58% versus 45%, P < .001) and chronic GVHD (cGVHD) (56% versus 42%, P < .001) were significantly higher with PBSC than with BM transplants. Rates of grade II-IV aGVHD were similar with PBSC and BM transplants. The 3-year probabilities of treatment-related mortality (TRM), leukemia recurrence, leukemia-free, and overall survival (OS) were similar in the 2 groups with 3-year leukemia-free survival rates of 30% and 32% after transplantation of PBSC and BM, respectively. Unlike results after HLA-matched sibling donor PBSC transplants, we did not identify a survival advantage with PBSC grafts in patients receiving unrelated donor transplants for advanced leukemia. The higher rate of cGVHD after PBSC transplants and, consequently, more frequent late adverse events warrant extended follow up of PBSC recipients.

Original languageEnglish (US)
Pages (from-to)1461-1468
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume13
Issue number12
DOIs
StatePublished - Dec 2007

Bibliographical note

Funding Information:
This work was supported by Public Health Service Grant U24-CA76518-08 from the National Cancer Institute, the National Institute of Allergy and Infectious Diseases, and the National Heart, Lung and Blood Institute, the National Marrow Donor Program of the U.S and the Department of Navy, Office of Naval Research grant #N00014-99-2-0006 to the National Marrow Donor Program. The findings, conclusions or recommendations expressed in this material are those of the authors and do not reflect the views of the Office of Naval Research or the National Marrow Donor Program. These data were presented at the 47th annual meeting of the American Society of Hematology in Atlanta, Georgia, December 2005.

Keywords

  • Graft-versus-host disease
  • Peripheral blood graft
  • Unrelated donor transplant

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