TY - JOUR
T1 - Allogeneic blood and bone-marrow stem-cell transplantation in haematological malignant diseases
T2 - A randomised trial
AU - Powles, Ray
AU - Mehta, Jayesh
AU - Kulkarni, Samar
AU - Treleaven, Jennifer
AU - Millar, Barbara
AU - Marsden, Jill
AU - Shepherd, Val
AU - Rowland, April
AU - Sirohi, Bhawna
AU - Tait, Diana
AU - Horton, Clive
AU - Long, Simon
AU - Singhal, Seema
N1 - Funding Information:
Our small study shows that use of PBSC compared with bone marrow for allogeneic transplantation results in faster haematopoietic recovery. This finding is supported by several retrospective studies 6,9–11 and one prospective study. 13 We have also shown that immune repopulation in the early post-transplant stages is better after PBSC transplantation. 20
PY - 2000/4/8
Y1 - 2000/4/8
N2 - Background. Autologous transplantation with peripheral blood stem cells (PBSC) results in faster haematopoietic-cell repopulation than with bone marrow. We prospectively compared bone marrow and PBSC for allogeneic transplantation. Methods. Adult HLA-identical sibling donors provided bone marrow and lenograstim-mobilised PBSC. 39 patients with malignant haematological disorders were infused with either bone marrow (n = 19) or PBSC (n = 20) after standard conditioning regimens in a double-blind, randomised fashion. The identity of the infused products for all patients remained masked until 1 year after the last patient had received transplantation. Findings. The PBSC group had significantly faster neutrophil recovery to 0.5 x 109/L (median 17.5 vs 23 days, p = 0.002), and platelet recovery to 20 x 109/L (median 11 vs 18 days, p < 0.0001) and to 50 x 109/L (median 20.5 vs 27 days, p = 0.02) than the bone-marrow group. PBS0 patients were discharged from hospital earlier than were bone-marrow patients (median 26 vs 31 days, p = 0.01). At 4 weeks after transplantation, absolute lymphocytes (0.48 vs 0.63, p = 0.08) and CD25 cells (0.04 vs 0.08, p = 0.007) were higher in the PBSC group, and the proportion of patients with absolute lymphopenia (74% vs 33%, p = 0.03) and CD4 lymphopenia (59% vs 24%, p = 0.05) was significantly higher in the bone-marrow group. There was no significant difference in the occurrence of acute or chronic graft-versus host disease and overall survival. The probability of relapse was significantly higher in the bone-marrow group than in the PBSC group (p = 0.01); all five relapses occurred among bone-marrow recipients. Interpretation. Our small study indicates that PBSCs are better than bone marrow for allogeneic transplantation from HLA-identical siblings in terms of faster haematopoietic and immune recovery, and have the potential to reduce disease recurrence.
AB - Background. Autologous transplantation with peripheral blood stem cells (PBSC) results in faster haematopoietic-cell repopulation than with bone marrow. We prospectively compared bone marrow and PBSC for allogeneic transplantation. Methods. Adult HLA-identical sibling donors provided bone marrow and lenograstim-mobilised PBSC. 39 patients with malignant haematological disorders were infused with either bone marrow (n = 19) or PBSC (n = 20) after standard conditioning regimens in a double-blind, randomised fashion. The identity of the infused products for all patients remained masked until 1 year after the last patient had received transplantation. Findings. The PBSC group had significantly faster neutrophil recovery to 0.5 x 109/L (median 17.5 vs 23 days, p = 0.002), and platelet recovery to 20 x 109/L (median 11 vs 18 days, p < 0.0001) and to 50 x 109/L (median 20.5 vs 27 days, p = 0.02) than the bone-marrow group. PBS0 patients were discharged from hospital earlier than were bone-marrow patients (median 26 vs 31 days, p = 0.01). At 4 weeks after transplantation, absolute lymphocytes (0.48 vs 0.63, p = 0.08) and CD25 cells (0.04 vs 0.08, p = 0.007) were higher in the PBSC group, and the proportion of patients with absolute lymphopenia (74% vs 33%, p = 0.03) and CD4 lymphopenia (59% vs 24%, p = 0.05) was significantly higher in the bone-marrow group. There was no significant difference in the occurrence of acute or chronic graft-versus host disease and overall survival. The probability of relapse was significantly higher in the bone-marrow group than in the PBSC group (p = 0.01); all five relapses occurred among bone-marrow recipients. Interpretation. Our small study indicates that PBSCs are better than bone marrow for allogeneic transplantation from HLA-identical siblings in terms of faster haematopoietic and immune recovery, and have the potential to reduce disease recurrence.
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U2 - 10.1016/S0140-6736(00)02090-0
DO - 10.1016/S0140-6736(00)02090-0
M3 - Article
C2 - 10770306
AN - SCOPUS:18844463655
SN - 0140-6736
VL - 355
SP - 1231
EP - 1237
JO - The Lancet
JF - The Lancet
IS - 9211
ER -