Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: An individual patient data meta-analysis of nine randomized trials

Mahmoud Al-Jurf, Francisco Aranha, Claudio Annasetti, Jane F. Apperley, Roy Baynes, William I. Bensinger, Didier Blaise, M. Ashraf Chaudhary, Mike Clarke, Jan J. Cornelissen, Stephen Couban, Corey Cutler, Benjamin Djulbegovic, Martin Gyger, Alois Gratwohl, Dag Heldal, Robert K. Hills, Bronno Van Der Holt, Iztok Hozo, Mathieu KuentzAmbuj Kumar, Jeff Lipton, James Matcham, Mohamad Mohty, James Morton, Tony Panzarella, Ray Powles, Sue M. Richards, Entezam Sahovic, Norbert Schmitz, David R. Simpson, Bhawna Sirohi, Heloisa P. Soares, Carmino A. De Souza, Afonso C. Vigorito, Keith Wheatley

Research output: Contribution to journalArticle

Abstract

Purpose: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. Patients and Methods: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95% CI, 0.25 to 0.38; P <.00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P <.00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P <.000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P <.000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage- (33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01). Conclusion: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.

Original languageEnglish (US)
Pages (from-to)5074-5087
Number of pages14
JournalJournal of Clinical Oncology
Volume23
Issue number22
DOIs
StatePublished - 2005

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Hematologic Neoplasms
Bone Marrow Transplantation
Peripheral Blood Stem Cell Transplantation
Meta-Analysis
Odds Ratio
Disease-Free Survival
Peripheral Blood Stem Cells
Recurrence
Graft vs Host Disease
Uncertainty
Neutrophils
Blood Platelets
Survival
Mortality

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies : An individual patient data meta-analysis of nine randomized trials. / Al-Jurf, Mahmoud; Aranha, Francisco; Annasetti, Claudio; Apperley, Jane F.; Baynes, Roy; Bensinger, William I.; Blaise, Didier; Chaudhary, M. Ashraf; Clarke, Mike; Cornelissen, Jan J.; Couban, Stephen; Cutler, Corey; Djulbegovic, Benjamin; Gyger, Martin; Gratwohl, Alois; Heldal, Dag; Hills, Robert K.; Van Der Holt, Bronno; Hozo, Iztok; Kuentz, Mathieu; Kumar, Ambuj; Lipton, Jeff; Matcham, James; Mohty, Mohamad; Morton, James; Panzarella, Tony; Powles, Ray; Richards, Sue M.; Sahovic, Entezam; Schmitz, Norbert; Simpson, David R.; Sirohi, Bhawna; Soares, Heloisa P.; De Souza, Carmino A.; Vigorito, Afonso C.; Wheatley, Keith.

In: Journal of Clinical Oncology, Vol. 23, No. 22, 2005, p. 5074-5087.

Research output: Contribution to journalArticle

Al-Jurf, M, Aranha, F, Annasetti, C, Apperley, JF, Baynes, R, Bensinger, WI, Blaise, D, Chaudhary, MA, Clarke, M, Cornelissen, JJ, Couban, S, Cutler, C, Djulbegovic, B, Gyger, M, Gratwohl, A, Heldal, D, Hills, RK, Van Der Holt, B, Hozo, I, Kuentz, M, Kumar, A, Lipton, J, Matcham, J, Mohty, M, Morton, J, Panzarella, T, Powles, R, Richards, SM, Sahovic, E, Schmitz, N, Simpson, DR, Sirohi, B, Soares, HP, De Souza, CA, Vigorito, AC & Wheatley, K 2005, 'Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: An individual patient data meta-analysis of nine randomized trials', Journal of Clinical Oncology, vol. 23, no. 22, pp. 5074-5087. https://doi.org/10.1200/JCO.2005.09.020
Al-Jurf, Mahmoud ; Aranha, Francisco ; Annasetti, Claudio ; Apperley, Jane F. ; Baynes, Roy ; Bensinger, William I. ; Blaise, Didier ; Chaudhary, M. Ashraf ; Clarke, Mike ; Cornelissen, Jan J. ; Couban, Stephen ; Cutler, Corey ; Djulbegovic, Benjamin ; Gyger, Martin ; Gratwohl, Alois ; Heldal, Dag ; Hills, Robert K. ; Van Der Holt, Bronno ; Hozo, Iztok ; Kuentz, Mathieu ; Kumar, Ambuj ; Lipton, Jeff ; Matcham, James ; Mohty, Mohamad ; Morton, James ; Panzarella, Tony ; Powles, Ray ; Richards, Sue M. ; Sahovic, Entezam ; Schmitz, Norbert ; Simpson, David R. ; Sirohi, Bhawna ; Soares, Heloisa P. ; De Souza, Carmino A. ; Vigorito, Afonso C. ; Wheatley, Keith. / Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies : An individual patient data meta-analysis of nine randomized trials. In: Journal of Clinical Oncology. 2005 ; Vol. 23, No. 22. pp. 5074-5087.
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title = "Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies: An individual patient data meta-analysis of nine randomized trials",
abstract = "Purpose: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. Patients and Methods: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95{\%} CI, 0.25 to 0.38; P <.00001) and platelet engraftment (OR = 0.52; 95{\%} CI, 0.44 to 0.61; P <.00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95{\%} CI, 1.03 to 1.88) and extensive (47{\%} v 31{\%} at 3 years; OR = 1.89; 95{\%} CI, 1.47 to 2.42; P <.000001) and overall chronic GVHD (68{\%} v 52{\%} at 3 years; OR = 1.92; 95{\%} CI, 1.47 to 2.49; P <.000001), but not grade 2-4 acute GVHD (54{\%} v 53{\%}; P = .49). PBSCT was associated with a decrease in relapse (21{\%} v 27{\%} at 3 years; OR = 0.71; 95{\%} CI, 0.54 to 0.93; P = .01) in both late-stage- (33{\%} v 51{\%} at 3 years; OR = 0.59; 95{\%} CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16{\%} v 20{\%} at 3 years; OR = 0.69; 95{\%} CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46{\%} v 31{\%} at 3 years; OR = 0.64; 95{\%} CI, 0.46 to 0.90; P = .01; disease-free survival: 41{\%} v 27{\%} at 3 years; OR = 0.63 95{\%} CI, 0.45 to 0.87; P = .01). Conclusion: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.",
author = "Mahmoud Al-Jurf and Francisco Aranha and Claudio Annasetti and Apperley, {Jane F.} and Roy Baynes and Bensinger, {William I.} and Didier Blaise and Chaudhary, {M. Ashraf} and Mike Clarke and Cornelissen, {Jan J.} and Stephen Couban and Corey Cutler and Benjamin Djulbegovic and Martin Gyger and Alois Gratwohl and Dag Heldal and Hills, {Robert K.} and {Van Der Holt}, Bronno and Iztok Hozo and Mathieu Kuentz and Ambuj Kumar and Jeff Lipton and James Matcham and Mohamad Mohty and James Morton and Tony Panzarella and Ray Powles and Richards, {Sue M.} and Entezam Sahovic and Norbert Schmitz and Simpson, {David R.} and Bhawna Sirohi and Soares, {Heloisa P.} and {De Souza}, {Carmino A.} and Vigorito, {Afonso C.} and Keith Wheatley",
year = "2005",
doi = "10.1200/JCO.2005.09.020",
language = "English (US)",
volume = "23",
pages = "5074--5087",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "22",

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TY - JOUR

T1 - Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies

T2 - An individual patient data meta-analysis of nine randomized trials

AU - Al-Jurf, Mahmoud

AU - Aranha, Francisco

AU - Annasetti, Claudio

AU - Apperley, Jane F.

AU - Baynes, Roy

AU - Bensinger, William I.

AU - Blaise, Didier

AU - Chaudhary, M. Ashraf

AU - Clarke, Mike

AU - Cornelissen, Jan J.

AU - Couban, Stephen

AU - Cutler, Corey

AU - Djulbegovic, Benjamin

AU - Gyger, Martin

AU - Gratwohl, Alois

AU - Heldal, Dag

AU - Hills, Robert K.

AU - Van Der Holt, Bronno

AU - Hozo, Iztok

AU - Kuentz, Mathieu

AU - Kumar, Ambuj

AU - Lipton, Jeff

AU - Matcham, James

AU - Mohty, Mohamad

AU - Morton, James

AU - Panzarella, Tony

AU - Powles, Ray

AU - Richards, Sue M.

AU - Sahovic, Entezam

AU - Schmitz, Norbert

AU - Simpson, David R.

AU - Sirohi, Bhawna

AU - Soares, Heloisa P.

AU - De Souza, Carmino A.

AU - Vigorito, Afonso C.

AU - Wheatley, Keith

PY - 2005

Y1 - 2005

N2 - Purpose: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. Patients and Methods: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95% CI, 0.25 to 0.38; P <.00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P <.00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P <.000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P <.000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage- (33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01). Conclusion: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.

AB - Purpose: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. Patients and Methods: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95% CI, 0.25 to 0.38; P <.00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P <.00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P <.000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P <.000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage- (33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01). Conclusion: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.

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