Mobilized peripheral blood stem cells versus unstimulated bone marrow as a graft source for T-cell–replete haploidentical donor transplantation using post-transplant cyclophosphamide Journal Article

Authors: Bashey, A.; Zhang, M. J.; McCurdy, S. R.; St. Martin, A.; Argall, T.; Anasetti, C.; Ciurea, S. O.; Fasan, O.; Gaballa, S.; Hamadani, M.; Munshi, P.; al Malki, M. M.; Nakamura, R.; O'Donnell, P. V.; Perales, M. A.; Raj, K.; Romee, R.; Rowley, S.; Rocha, V.; Salit, R. B.; Solh, M.; Soiffer, R. J.; Fuchs, E. J.; Eapen, M.
Article Title: Mobilized peripheral blood stem cells versus unstimulated bone marrow as a graft source for T-cell–replete haploidentical donor transplantation using post-transplant cyclophosphamide
Abstract: Purpose T-cell–replete HLA-haploidentical donor hematopoietic transplantation using post-transplant cyclophosphamide was originally described using bone marrow (BM). With increasing use of mobilized peripheral blood (PB), we compared transplant outcomes after PB and BM transplants. Patients and Methods A total of 681 patients with hematologic malignancy who underwent transplantation in the United States between 2009 and 2014 received BM (n = 481) or PB (n = 190) grafts. Cox regression models were built to examine differences in transplant outcomes by graft type, adjusting for patient, disease, and transplant characteristics. Results Hematopoietic recovery was similar after transplantation of BM and PB (28-day neutrophil recovery, 88% v 93%, P = .07; 100-day platelet recovery, 88% v 85%, P = .33). Risks of grade 2 to 4 acute (hazard ratio [HR], 0.45; P, .001) and chronic (HR, 0.35; P, .001) graft-versus-host disease were lower with transplantation of BM compared with PB. There were no significant differences in overall survival by graft type (HR, 0.99; P = .98), with rates of 54% and 57% at 2 years after transplantation of BM and PB, respectively. There were no differences in nonrelapse mortality risks (HR, 0.92; P = .74) but relapse risks were higher after transplantation of BM (HR, 1.49; P = .009). Additional exploration confirmed that the higher relapse risks after transplantation of BM were limited to patients with leukemia (HR, 1.73; P = .002) and not lymphoma (HR, 0.87; P = .64). Conclusion PB and BM grafts are suitable for haploidentical transplantation with the post-transplant cyclophosphamide approach but with differing patterns of treatment failure. Although, to our knowledge, this is the most comprehensive comparison, these findings must be validated in a randomized prospective comparison with adequate follow-up. Copyright © 2017 American Society of Clinical Oncology. All rights reserved.
Keywords: adolescent; adult; aged; middle aged; leukemia; young adult; human cell; major clinical study; overall survival; clinical trial; cancer recurrence; conference paper; cancer incidence; t lymphocyte; t-lymphocytes; cytology; bone marrow; haplotypes; cyclophosphamide; stem cell transplantation; cancer mortality; haplotype; immunology; chronic graft versus host disease; graft failure; hematologic malignancy; donor; hematologic neoplasms; neutrophil; peripheral blood stem cell; multicenter study; lymphoma; graft versus host reaction; stem cell mobilization; hematopoietic stem cells; transplantation conditioning; hematopoietic stem cell; bone marrow transplantation; donor selection; hematopoietic stem cell mobilization; recurrence free survival; procedures; haploidy; humans; human; male; female; priority journal; mortality risk
Journal Title: Journal of Clinical Oncology
Volume: 35
Issue: 26
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2017-09-10
Start Page: 3002
End Page: 3009
Language: English
DOI: 10.1200/jco.2017.72.8428
PUBMED: 28644773
PROVIDER: scopus
PMCID: PMC5590802
Notes: Conference Paper -- Export Date: 2 October 2017 -- Source: Scopus
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MSK Authors
  1. Miguel-Angel Perales
    355 Perales