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 journalArticlepeer-review

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

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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