TY - JOUR
T1 - A comparison of related donor peripheral blood and bone marrow transplants
T2 - Importance of late-onset chronic graft-versus-host disease and infections
AU - Anderson, Daniel
AU - DeFor, Todd
AU - Burns, Linda
AU - McGlave, Philip
AU - Miller, Jeffrey
AU - Wagner, John
AU - Weisdorf, Daniel
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2003/1
Y1 - 2003/1
N2 - Peripheral blood hematopoietic stem cell (PBSC) transplants have been shown to result in more rapid engraftment than standard bone marrow transplants (BMTs). Little comparative data exist regarding complications in patients receiving transplants using these stem cell sources. In our study, 97 adults with advanced hematologic malignancies who received allogeneic PBSC transplants were compared with 97 adults who received allogeneic BMTs using identical preparative regimens and support parameters. The incidence of systemic infections and other major complications occurring within the first year after transplantation were calculated in both groups. Proportional hazard analysis was used to examine risk factors for death and complications in both groups. Patients receiving PBSC transplants had more rapid neutrophil (17 days versus 24 days; P < .001) and platelet engraftment (28 days versus 47 days; P < .001) than BMT recipients. The survival rate at 2 years was 38% in PBSC transplant recipients and 28% in marrow recipients (P = .08). There was no difference in rates of grade II to IV acute graft-versus-host disease (GVHD) between groups (PBSC 46%, BMT 51%; P = .3). PBSC transplant recipients were more likely to develop chronic GVHD after 180 days (hazard ratio 2.2; P = .05). Accompanying this "late-onset chronic GVHD," a pattern of more frequent late systemic fungal and cytomegalovirus infections was observed in PBSC transplant recipients. In conclusion, although PBSC transplant recipients engraft more quickly than BMT recipients and have somewhat better 2-year survival rates, they develop more frequent late-onset chronic GVHD and may have more late fungal and cytomegalovirus infections than marrow recipients. Further studies must examine this late-onset chronic GVHD and better characterize immune reconstitution in PBSC transplant recipients to understand their effects on patient recovery.
AB - Peripheral blood hematopoietic stem cell (PBSC) transplants have been shown to result in more rapid engraftment than standard bone marrow transplants (BMTs). Little comparative data exist regarding complications in patients receiving transplants using these stem cell sources. In our study, 97 adults with advanced hematologic malignancies who received allogeneic PBSC transplants were compared with 97 adults who received allogeneic BMTs using identical preparative regimens and support parameters. The incidence of systemic infections and other major complications occurring within the first year after transplantation were calculated in both groups. Proportional hazard analysis was used to examine risk factors for death and complications in both groups. Patients receiving PBSC transplants had more rapid neutrophil (17 days versus 24 days; P < .001) and platelet engraftment (28 days versus 47 days; P < .001) than BMT recipients. The survival rate at 2 years was 38% in PBSC transplant recipients and 28% in marrow recipients (P = .08). There was no difference in rates of grade II to IV acute graft-versus-host disease (GVHD) between groups (PBSC 46%, BMT 51%; P = .3). PBSC transplant recipients were more likely to develop chronic GVHD after 180 days (hazard ratio 2.2; P = .05). Accompanying this "late-onset chronic GVHD," a pattern of more frequent late systemic fungal and cytomegalovirus infections was observed in PBSC transplant recipients. In conclusion, although PBSC transplant recipients engraft more quickly than BMT recipients and have somewhat better 2-year survival rates, they develop more frequent late-onset chronic GVHD and may have more late fungal and cytomegalovirus infections than marrow recipients. Further studies must examine this late-onset chronic GVHD and better characterize immune reconstitution in PBSC transplant recipients to understand their effects on patient recovery.
KW - Bone marrow transplantation
KW - Complications
KW - Graft-versus-host disease
KW - Peripheral blood hematopoietic stem cell
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U2 - 10.1053/bbmt.2003.50000
DO - 10.1053/bbmt.2003.50000
M3 - Article
C2 - 12533742
AN - SCOPUS:0141723595
SN - 1083-8791
VL - 9
SP - 52
EP - 59
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 1
ER -