Comparison of granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood progenitor cells and G-CSF-stimulated bone marrow as a source of stem cells in HLA-matched sibling transplantation

HLA-identical bone marrow or stem cell transplantation from a sibling is th e preferred treatment for patients with chronic myelogenous leukemia, bone marrow failure syndromes, relapsed acute leukemia, and specific inborn erro rs of metabolism. Several groups have shown that granulocyte colony-stimula ting factor (G-CSF)-mobilized peripheral blood progenitor cells (PBPCs) obt ained from HLA-matched siblings are effective in reconstitution of marrow f unction after marrow ablative conditioning therapy. To evaluate whether G-C SF treatment before bone marrow harvest leads to enhanced recovery of PBPC counts and recovery from limited graft-versus-host disease (GVHD), we asses sed the outcome of a sequential cohort of patients treated identically and then given either G-CSF-mobilized PBPCs or G-CSF-stimulated bone marrow fro m HLA-identical siblings. We show that the time to neutrophil engraftment i s identical in the 2 cohorts, whereas platelet engraftment is earlier with the use of PBPCs. The incidence of acute GVHD was decreased, and that of ch ronic GVHD significantly decreased, in the group receiving bone marrow Over all survival was not different between the 2 groups. Thus, G-CSF-stimulated bone marrow offers a source of stem cells that allows for early neutrophil engraftment with a decreased risk of GVI-ID.