Transplantation of Peripheral Blood Stem Cells as Compared With Bone Marrow From HLA-Identical Siblings in Adult Patients With Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia

Several studies show that allogeneic peripheral blood stem cells (PBSCs) engraft more rapidly than bone marrow (BM). However, the data are inconsistent with regard to acute and chronic graft-versus-host disease (GVHD), relapse, transplant-related mortality (TRM), and leukemia-free survival (LFS). Be...

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Veröffentlicht in:Journal of clinical oncology 2002-12, Vol.20 (24), p.4655-4664
Hauptverfasser: RINGDEN, O, LABOPIN, M, SCHATTENBERG, A, FRASSONI, F, BACIGALUPO, A, ARCESE, W, SCHAEFER, U. W, WILLEMZE, R, KOC, H, BUNJES, D, GLUCKMAN, E, ROCHA, V
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container_end_page 4664
container_issue 24
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container_title Journal of clinical oncology
container_volume 20
creator RINGDEN, O
LABOPIN, M
SCHATTENBERG, A
FRASSONI, F
BACIGALUPO, A
ARCESE, W
SCHAEFER, U. W
WILLEMZE, R
KOC, H
BUNJES, D
GLUCKMAN, E
ROCHA, V
description Several studies show that allogeneic peripheral blood stem cells (PBSCs) engraft more rapidly than bone marrow (BM). However, the data are inconsistent with regard to acute and chronic graft-versus-host disease (GVHD), relapse, transplant-related mortality (TRM), and leukemia-free survival (LFS). Between January 1994 and December 2000, 3,465 adult patients (older than 15 years of age) were reported to the European Group for Blood and Marrow Transplantation Registry from 224 centers. Among acute myeloid leukemia (AML) patients, 1,537 patients received BM and 757 patients received PBSC. In acute lymphoblastic leukemia (ALL) patients, the corresponding figures were 826 versus 345 patients who were analyzed for engraftment, GVHD, TRM, relapse, LFS, and survival. In multivariate analysis, the recovery of neutrophils and platelets was faster with PBSC than with BM (P
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In acute lymphoblastic leukemia (ALL) patients, the corresponding figures were 826 versus 345 patients who were analyzed for engraftment, GVHD, TRM, relapse, LFS, and survival. In multivariate analysis, the recovery of neutrophils and platelets was faster with PBSC than with BM (P &lt;.0001). Chronic GVHD was associated with PBSC in patients with AML (relative risk [RR], 2.11; 95% confidence interval, 1.66 to 2.7; P &lt;.0001) and ALL (RR, 1.56; 95% confidence interval, 1.09 to 2.27; P =.02). PBSC versus BM in patients with AML or ALL was not significantly associated with acute GVHD, TRM, relapse, survival, or LFS. In multivariate analysis of patients with AML, factors significantly associated with improved LFS included first remission at transplant (P &lt;.0001), promyelocytic leukemia (M3) versus other French-American-British types (P &lt;.0001), and donor age below median 37 years (P =.02). 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W</creatorcontrib><creatorcontrib>WILLEMZE, R</creatorcontrib><creatorcontrib>KOC, H</creatorcontrib><creatorcontrib>BUNJES, D</creatorcontrib><creatorcontrib>GLUCKMAN, E</creatorcontrib><creatorcontrib>ROCHA, V</creatorcontrib><title>Transplantation of Peripheral Blood Stem Cells as Compared With Bone Marrow From HLA-Identical Siblings in Adult Patients With Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia</title><title>Journal of clinical oncology</title><addtitle>J Clin Oncol</addtitle><description>Several studies show that allogeneic peripheral blood stem cells (PBSCs) engraft more rapidly than bone marrow (BM). However, the data are inconsistent with regard to acute and chronic graft-versus-host disease (GVHD), relapse, transplant-related mortality (TRM), and leukemia-free survival (LFS). Between January 1994 and December 2000, 3,465 adult patients (older than 15 years of age) were reported to the European Group for Blood and Marrow Transplantation Registry from 224 centers. Among acute myeloid leukemia (AML) patients, 1,537 patients received BM and 757 patients received PBSC. In acute lymphoblastic leukemia (ALL) patients, the corresponding figures were 826 versus 345 patients who were analyzed for engraftment, GVHD, TRM, relapse, LFS, and survival. In multivariate analysis, the recovery of neutrophils and platelets was faster with PBSC than with BM (P &lt;.0001). Chronic GVHD was associated with PBSC in patients with AML (relative risk [RR], 2.11; 95% confidence interval, 1.66 to 2.7; P &lt;.0001) and ALL (RR, 1.56; 95% confidence interval, 1.09 to 2.27; P =.02). PBSC versus BM in patients with AML or ALL was not significantly associated with acute GVHD, TRM, relapse, survival, or LFS. In multivariate analysis of patients with AML, factors significantly associated with improved LFS included first remission at transplant (P &lt;.0001), promyelocytic leukemia (M3) versus other French-American-British types (P &lt;.0001), and donor age below median 37 years (P =.02). In patients with ALL, first remission (P &lt;.0001) and methotrexate included in the immunosuppressive regimen (P =.001) were associated with improved LFS. Allogeneic PBSC results in faster neutrophil and platelet engraftment and a higher incidence of chronic GVHD than BM. However, acute GVHD, TRM, relapse, survival, and LFS were similar in patients receiving PBSCs versus BM.</description><subject>Acute Disease</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Bone Marrow Transplantation</subject><subject>Bone marrow, stem cells transplantation. Graft versus host reaction</subject><subject>Chronic Disease</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Graft vs Host Disease - etiology</subject><subject>Hematologic and hematopoietic diseases</subject><subject>HLA Antigens</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Leukemia, Myelomonocytic, Acute - mortality</subject><subject>Leukemia, Myelomonocytic, Acute - therapy</subject><subject>Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Methotrexate - therapeutic use</subject><subject>Multivariate Analysis</subject><subject>Peripheral Blood Stem Cell Transplantation</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality</subject><subject>Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy</subject><subject>Retrospective Studies</subject><subject>Transfusions. Complications. Transfusion reactions. 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Between January 1994 and December 2000, 3,465 adult patients (older than 15 years of age) were reported to the European Group for Blood and Marrow Transplantation Registry from 224 centers. Among acute myeloid leukemia (AML) patients, 1,537 patients received BM and 757 patients received PBSC. In acute lymphoblastic leukemia (ALL) patients, the corresponding figures were 826 versus 345 patients who were analyzed for engraftment, GVHD, TRM, relapse, LFS, and survival. In multivariate analysis, the recovery of neutrophils and platelets was faster with PBSC than with BM (P &lt;.0001). Chronic GVHD was associated with PBSC in patients with AML (relative risk [RR], 2.11; 95% confidence interval, 1.66 to 2.7; P &lt;.0001) and ALL (RR, 1.56; 95% confidence interval, 1.09 to 2.27; P =.02). PBSC versus BM in patients with AML or ALL was not significantly associated with acute GVHD, TRM, relapse, survival, or LFS. In multivariate analysis of patients with AML, factors significantly associated with improved LFS included first remission at transplant (P &lt;.0001), promyelocytic leukemia (M3) versus other French-American-British types (P &lt;.0001), and donor age below median 37 years (P =.02). In patients with ALL, first remission (P &lt;.0001) and methotrexate included in the immunosuppressive regimen (P =.001) were associated with improved LFS. Allogeneic PBSC results in faster neutrophil and platelet engraftment and a higher incidence of chronic GVHD than BM. However, acute GVHD, TRM, relapse, survival, and LFS were similar in patients receiving PBSCs versus BM.</abstract><cop>Baltimore, MD</cop><pub>American Society of Clinical Oncology</pub><pmid>12488410</pmid><doi>10.1200/JCO.2002.12.049</doi><tpages>10</tpages></addata></record>
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subjects Acute Disease
Adolescent
Adult
Age Factors
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Bone Marrow Transplantation
Bone marrow, stem cells transplantation. Graft versus host reaction
Chronic Disease
Disease-Free Survival
Female
Graft vs Host Disease - etiology
Hematologic and hematopoietic diseases
HLA Antigens
Humans
Immunosuppressive Agents - therapeutic use
Leukemia, Myelomonocytic, Acute - mortality
Leukemia, Myelomonocytic, Acute - therapy
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Male
Medical sciences
Methotrexate - therapeutic use
Multivariate Analysis
Peripheral Blood Stem Cell Transplantation
Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy
Retrospective Studies
Transfusions. Complications. Transfusion reactions. Cell and gene therapy
title Transplantation of Peripheral Blood Stem Cells as Compared With Bone Marrow From HLA-Identical Siblings in Adult Patients With Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia
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