A comparative study of peripheral blood stem cell vs bone marrow transplantation from unrelated donors (MUD): a single center study

Peripheral blood stem cell transplants (PBSCT) from unrelated donors (n = 3 7) were compared with bone marrow transplants (BM, bone marrow group, n = 3 7) in a matched pair analysis. Ten patients (2, class 1) in the alloPBSCT g roup and seven patients (2, class 1) in the BM group had one HLA locus mism atch donor, respectively. The following factors were matched: HLA-compatibi lity, diagnosis, disease stage, age and gender. The median age in the PBSC group was 37 years (1956, excluding one 6-year-old child) and in the BM gro up 37 years (18-53). The BM group consisted of 12 females and 25 males, 17 females and 20 males were in the PBSC group. Twelve patients in the BM and 11 patients in the PBSC group were diagnosed with AML; 7/7, ALL; 15/15, CML ; 2/3, MDS; 1/1, NHL. Thirty-four (14/20) of the 74 patients (45%) were con sidered as high risk patients. The conditioning regimen was BU/CY for stand ard risk patients with myeloid diseases (31 patients) and TBI/CY for ALL an d NHL patients (36 patients); six patients received intensified conditionin g with VP-16 (2 patients), thiotepa (2 patients) or melphalan (1 patient). The GVHD prophylaxis regimen was used according to the Seattle protocol. DF S was 51% (19 patients) with a median of 352 days and 59% (21 patients) wit h a median of 760 days, in PBSC and BM transplants, respectively. The media n time to leukocyte engraftment in PBSC patients was 14 days (range 6-26 da ys) and in the BM group 19 days (range 9-29 days; P < 0.02). The time of pl atelet engraftment did not differ significantly between the groups. The inc idence of grade II-IV acute GVHD was 40% (four patients died, 13%) in the P BSC group and 20% (three patients died, 8%) in the BM group, respectively ( P < 0.05, log-rank). No signs of aGVHD were found in 19% of the patients in the PBSC and 27% in the BM group. Our results indicate that allogeneic PBS CT does lead to a significantly faster leukocyte engraftment. The significa nt increase with regard to the incidence and shorter time of onset of sever e aGVHD in PBSC patients, compared to marrow transplant patients, need to b e confirmed in a randomised trial.