Abstract
Peripheral blood (PB) and bone marrow (BM) from unrelated donors can serve as a graft source for hematopoietic cell transplantation (HCT). Currently, PB is most commonly used in roughly 80% of adult recipients. Determining the long-term impact of graft source on outcomes would inform this decision. Data collected by the Center for International Blood and Marrow Transplant Research from 5200 adult recipients of a first HCT from an 8/8 or 7/8 HLA antigen-matched unrelated donor for treatment of acute leukemia, chronic myelogenous leukemia, or myelodysplastic syndrome between 2001 and 2011 were analyzed to determine the impact of graft source on graft-versus-host disease (GVHD) relapse-free survival (GRFS), defined as freedom from grade III/IV acute GVHD, chronic GVHD requiring immunosuppressive therapy, relapse, and death, and overall survival. GRFS at 2 years was superior in BM recipients compared with PB recipients (16%; 95% confidence interval [CI], 14% to 18% versus 10%; 95% CI, 8% to 11%; P <.0001) in the 8/8 HLA-matched cohort and 7/8 HLA-matched cohort (11%; 95% CI, 8% to 14% versus 5%; 95% CI, 4% to 7%; P =.001). With 8/8 HLA-matched unrelated donors, overall survival at 5 years was superior in recipients of BM (43%; 95% CI, 40% to 46% versus 38%; 95% CI, 36% to 40%; P =.014). The inferior 5-year survival in the PB cohort was attributable to a higher frequency of deaths while in remission compared with the BM cohort. For recipients of 7/8 HLA-matched grafts, survival at 5 years was similar in BM recipients and PB recipients (32% versus 29%; P =.329). BM grafts are associated with improved long-term GRFS and overall survival in recipients of matched unrelated donor HCT and should be considered the unrelated allograft of choice, when available, for adults with acute leukemia, chronic myelogenous leukemia, and myelodysplastic syndrome.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 270-278 |
| Number of pages | 9 |
| Journal | Biology of Blood and Marrow Transplantation |
| Volume | 25 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 2019 |
Bibliographical note
Funding Information:Financial disclosure: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute (NCI), National Heart, Lung and Blood Institute (NHLBI) , and National Institute of Allergy and Infectious Diseases ; Grant/Cooperative Agreement 4U10HL069294 from the NHLBI and NCI ; Contract HHSH250201200016C with the Health Resources and Services Administration ; Grants N00014-17-1-2388 and N0014-17-1-2850 from the Office of Naval Research; and Grants from *Actinium Pharmaceuticals; *Amgen; *Amneal Biosciences; *Angiocrine Bioscience; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics; Be the Match Foundation; *bluebird bio; *Bristol Myers Squibb Oncology; *Celgene; Cerus; *Chimerix; Fred Hutchinson Cancer Research Center; Gamida Cell; Gilead Sciences; HistoGenetics; Immucor; *Incyte; Janssen Scientific Affairs; *Jazz Pharmaceuticals; Juno Therapeutics; Karyopharm Therapeutics; Kite Pharma; Medac; MedImmune; Medical College of Wisconsin; *Mediware; *Merck & Co; *Mesoblast; MesoScale Diagnostics; Millennium, the Takeda Oncology Company; *Miltenyi Biotec; National Marrow Donor Program; *Neovii Biotech NA; Novartis Pharmaceuticals; Otsuka Pharmaceuticals; PCORI; *Pfizer; *Pharmacyclics; PIRCHE; *Sanofi Genzyme; *Seattle Genetics; Shire; Spectrum Pharmaceuticals; St. Baldrick's Foundation; *Sunesis Pharmaceuticals; Swedish Orphan Biovitrum; Takeda Oncology; Telomere Diagnostics; and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, Health Resources and Services Administration, or any other agency of the US Government.
Funding Information:
Financial disclosure: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute (NCI), National Heart, Lung and Blood Institute (NHLBI), and National Institute of Allergy and Infectious Diseases; Grant/Cooperative Agreement 4U10HL069294 from the NHLBI and NCI; Contract HHSH250201200016C with the Health Resources and Services Administration; Grants N00014-17-1-2388 and N0014-17-1-2850 from the Office of Naval Research; and Grants from *Actinium Pharmaceuticals; *Amgen; *Amneal Biosciences; *Angiocrine Bioscience; Anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics; Be the Match Foundation; *bluebird bio; *Bristol Myers Squibb Oncology; *Celgene; Cerus; *Chimerix; Fred Hutchinson Cancer Research Center; Gamida Cell; Gilead Sciences; HistoGenetics; Immucor; *Incyte; Janssen Scientific Affairs; *Jazz Pharmaceuticals; Juno Therapeutics; Karyopharm Therapeutics; Kite Pharma; Medac; MedImmune; Medical College of Wisconsin; *Mediware; *Merck & Co; *Mesoblast; MesoScale Diagnostics; Millennium, the Takeda Oncology Company; *Miltenyi Biotec; National Marrow Donor Program; *Neovii Biotech NA; Novartis Pharmaceuticals; Otsuka Pharmaceuticals; PCORI; *Pfizer; *Pharmacyclics; PIRCHE; *Sanofi Genzyme; *Seattle Genetics; Shire; Spectrum Pharmaceuticals; St. Baldrick's Foundation; *Sunesis Pharmaceuticals; Swedish Orphan Biovitrum; Takeda Oncology; Telomere Diagnostics; and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, Department of the Navy, Department of Defense, Health Resources and Services Administration, or any other agency of the US Government.
Publisher Copyright:
© 2018 Elsevier Ltd
Keywords
- bone marrow
- peripheral blood
- unrelated donor hematopoietic cell transplant
