No difference in graft-versus-host disease, relapse, and survival comparing peripheral stem cells to bone marrow using unrelated donors

The clinical results in 107 patients receiving a peripheral blood stem cell (PBSC) graft mobilized by granulocyte colony-stimulating factor (G-CSF) fr om HLA-A, -B, and -DR-compatible unrelated donors were compared to 107 matc hed controls receiving unrelated bone marrow (BMI) transplants. Engraftment was achieved in 94% of the patients in both groups. The PBSC graft contain ed significantly more nucleated cells, CD34(+), CD3(+), and CD56(+) cells ( P < .001), and resulted in a significantly shorter time-to-neutrophil (15 v ersus 19 days) and platelet engraftment (20 versus 27 days), compared to th e BM control group (P < .001). Probabilities of acute graft-versus-host dis ease (GVHD) grades II to IV were 35% and 32% (not significant [NS]) and of chronic GVHD 61% and 76% (NS) in the PBSC and BM groups, respectively. Ther e was no difference between the 2 groups in bacteremia, cytomegalovirus rea ctivation or disease, and fungal infection. The 3-year transplant-related m ortality (TRM) rates were 42% in the PBSC group and 31% in the BM controls (P = .7) and the survival rates were 46% and 51%, respectively, The probabi lity of relapse was 25% and 31% in both groups (NS), resulting in disease-f ree survival rates of 43% in the PBSC group and 46% in the BM controls (NS) . In the multivariate analysis, early disease, acute GVHD grade 0 to 1, and presence of chronic GVHD were independent factors associated with a better disease-free survival in this study. PBSC from HLA-compatible unrelated do nors can be used safely as an alternative to BM for stem cell transplantati on. (C) 2001 by The American Society of Hematology.