Blood stem cells compared with bone marrow as a source of hematopoietic cells for allogeneic transplantation

Peripheral blood cells are increasingly used in place of bone marrow as a s ource of hematopoietic stem cells for allogeneic transplantation. The relat ive efficacy of these 2 approaches is unknown. This retrospective multivari ate analysis compared results of 288 HLA-identical sibling blood stem cell transplantations with results of 536 HLA-identical sibling bone marrow tran splantations. No transplants were T-cell depleted, Median follow-up was 12 months, and analyses focused on 1-year outcomes, Recipients of blood stem c ell transplants had more rapid recovery of neutrophils to at least 0.5 x 10 (9)/L (median time to recovery, 14 days, compared with 19 days for marrow t ransplants; P < .001) and of platelets to at least 20 x 10(9)/L (median tim e, 18 days, compared with 25 days for marrow transplants; P < .001). There was no significant difference in the incidence of grades II to IV acute gra ft versus host disease (GVHD), The incidence of chronic GVHD was significan tly higher after blood stem cell transplantation (1-year probability [95% c onfidence interval], 65% [56%-72%] compared with 53% [47%-59%]; P = .02) Re lapse incidence in the 2 transplant groups did not differ significantly. Tr eatment-related mortality rates were lower and leukemia-free survival rates were higher with blood stem cell transplants in patients with advanced leu kemia (acute leukemia in second remission or chronic myelogenous leukemia i n accelerated phase) but not in early leukemia (acute leukemia in first rem ission or chronic myelogenous leukemia in chronic phase). The median time f rom transplantation to hospital discharge was 23 days after blood stem cell transplantation and 28 days after bone marrow transplantation (P = .003). Further study with longer follow-up is necessary to definitively establish the role of blood stem cells for allogeneic transplantation, especially in patients with good-risk disease. (C) 2000 by The American Society of Hemato logy.