Bone marrow versus mobilized peripheral blood stem cells in haploidentical transplants using posttransplantation cyclophosphamide

Annalisa Ruggeri, Myriam Labopin, Andrea Bacigalupo, Zafer Gülbas, Yener Koc, Didier Blaise, Benedetto Bruno, Giuseppe Irrera, Johanna Tischer, Jose Luiz Diez-Martin, Luca Castagna, Fabio Ciceri, Mohamad Mohty, Arnon Nagler

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Abstract

BACKGROUND: Incidence of graft-versus-host disease (GVHD) in haploidentical bone marrow (BM) transplants using posttransplantion cyclophosphamide (PT-Cy) is low, whereas GVHD using mobilized peripheral blood stem cells (PBSC) ranges between 30% and 40%. METHODS: To evaluate the effect of stem cell source in haploidentical transplantation with PT-Cy, we analyzed 451 patients transplanted for acute myeloid leukemia or acute lymphoblastic leukemia reported to the European Society for Blood and Marrow Transplantation. RESULTS: BM was used in 260 patients, and PBSC were used in 191 patients. The median follow-up was 21 months. Engraftment was lower in BM (92% vs 95%, P < 0.001). BM was associated with a lower incidence of stage II-IV and stage III-IV acute GVHD (21% vs 38%, P ≤.01; and 4% vs 14%, P <.01, respectively). No difference in chronic GVHD, relapse, or nonrelapse mortality were found for PBSC or BM. The 2-year overall survival (OS) was 55% versus 56% (P =.57) and leukemia-free survival (LFS) was 49% versus 54% (P =.74) for BM and PBSC, respectively. On multivariate analysis, PBSC were associated with an increased risk of stage II-IV (hazard ratio [HR], 2.1; P <.001) and stage III-IV acute GVHD (HR, 3.8; P <.001). For LFS and OS, reduced intensity conditioning was the only factor associated with treatment failure (LFS: HR, 1.40; P =.04) and relapse (HR, 1.62; P =.02). CONCLUSION: In patients with acute leukemia in first or second remission receiving haploidentical transplantation with PT-Cy, the use of PBSC increases the risk of acute GVHD, whereas survival outcomes are comparable. Cancer 2018;124:1428-37.

Original languageEnglish
Pages (from-to)1428-1437
Number of pages10
JournalCancer
Volume124
Issue number7
DOIs
Publication statusPublished - Apr 1 2018

Fingerprint

Cyclophosphamide
Graft vs Host Disease
Bone Marrow
Transplants
Survival
Leukemia
Transplantation
Recurrence
Incidence
Peripheral Blood Stem Cells
Treatment Failure
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Acute Myeloid Leukemia
Stem Cells
Multivariate Analysis
Mortality
Neoplasms

Keywords

  • acute graft-versus-host disease
  • acute leukemia
  • haploidentical transplantation
  • posttransplantation cyclophosphamide
  • stem cell source

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Bone marrow versus mobilized peripheral blood stem cells in haploidentical transplants using posttransplantation cyclophosphamide. / Ruggeri, Annalisa; Labopin, Myriam; Bacigalupo, Andrea; Gülbas, Zafer; Koc, Yener; Blaise, Didier; Bruno, Benedetto; Irrera, Giuseppe; Tischer, Johanna; Diez-Martin, Jose Luiz; Castagna, Luca; Ciceri, Fabio; Mohty, Mohamad; Nagler, Arnon.

In: Cancer, Vol. 124, No. 7, 01.04.2018, p. 1428-1437.

Research output: Contribution to journalArticle

Ruggeri, A, Labopin, M, Bacigalupo, A, Gülbas, Z, Koc, Y, Blaise, D, Bruno, B, Irrera, G, Tischer, J, Diez-Martin, JL, Castagna, L, Ciceri, F, Mohty, M & Nagler, A 2018, 'Bone marrow versus mobilized peripheral blood stem cells in haploidentical transplants using posttransplantation cyclophosphamide', Cancer, vol. 124, no. 7, pp. 1428-1437. https://doi.org/10.1002/cncr.31228
Ruggeri, Annalisa ; Labopin, Myriam ; Bacigalupo, Andrea ; Gülbas, Zafer ; Koc, Yener ; Blaise, Didier ; Bruno, Benedetto ; Irrera, Giuseppe ; Tischer, Johanna ; Diez-Martin, Jose Luiz ; Castagna, Luca ; Ciceri, Fabio ; Mohty, Mohamad ; Nagler, Arnon. / Bone marrow versus mobilized peripheral blood stem cells in haploidentical transplants using posttransplantation cyclophosphamide. In: Cancer. 2018 ; Vol. 124, No. 7. pp. 1428-1437.
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abstract = "BACKGROUND: Incidence of graft-versus-host disease (GVHD) in haploidentical bone marrow (BM) transplants using posttransplantion cyclophosphamide (PT-Cy) is low, whereas GVHD using mobilized peripheral blood stem cells (PBSC) ranges between 30{\%} and 40{\%}. METHODS: To evaluate the effect of stem cell source in haploidentical transplantation with PT-Cy, we analyzed 451 patients transplanted for acute myeloid leukemia or acute lymphoblastic leukemia reported to the European Society for Blood and Marrow Transplantation. RESULTS: BM was used in 260 patients, and PBSC were used in 191 patients. The median follow-up was 21 months. Engraftment was lower in BM (92{\%} vs 95{\%}, P < 0.001). BM was associated with a lower incidence of stage II-IV and stage III-IV acute GVHD (21{\%} vs 38{\%}, P ≤.01; and 4{\%} vs 14{\%}, P <.01, respectively). No difference in chronic GVHD, relapse, or nonrelapse mortality were found for PBSC or BM. The 2-year overall survival (OS) was 55{\%} versus 56{\%} (P =.57) and leukemia-free survival (LFS) was 49{\%} versus 54{\%} (P =.74) for BM and PBSC, respectively. On multivariate analysis, PBSC were associated with an increased risk of stage II-IV (hazard ratio [HR], 2.1; P <.001) and stage III-IV acute GVHD (HR, 3.8; P <.001). For LFS and OS, reduced intensity conditioning was the only factor associated with treatment failure (LFS: HR, 1.40; P =.04) and relapse (HR, 1.62; P =.02). CONCLUSION: In patients with acute leukemia in first or second remission receiving haploidentical transplantation with PT-Cy, the use of PBSC increases the risk of acute GVHD, whereas survival outcomes are comparable. Cancer 2018;124:1428-37.",
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AU - Ruggeri, Annalisa

AU - Labopin, Myriam

AU - Bacigalupo, Andrea

AU - Gülbas, Zafer

AU - Koc, Yener

AU - Blaise, Didier

AU - Bruno, Benedetto

AU - Irrera, Giuseppe

AU - Tischer, Johanna

AU - Diez-Martin, Jose Luiz

AU - Castagna, Luca

AU - Ciceri, Fabio

AU - Mohty, Mohamad

AU - Nagler, Arnon

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N2 - BACKGROUND: Incidence of graft-versus-host disease (GVHD) in haploidentical bone marrow (BM) transplants using posttransplantion cyclophosphamide (PT-Cy) is low, whereas GVHD using mobilized peripheral blood stem cells (PBSC) ranges between 30% and 40%. METHODS: To evaluate the effect of stem cell source in haploidentical transplantation with PT-Cy, we analyzed 451 patients transplanted for acute myeloid leukemia or acute lymphoblastic leukemia reported to the European Society for Blood and Marrow Transplantation. RESULTS: BM was used in 260 patients, and PBSC were used in 191 patients. The median follow-up was 21 months. Engraftment was lower in BM (92% vs 95%, P < 0.001). BM was associated with a lower incidence of stage II-IV and stage III-IV acute GVHD (21% vs 38%, P ≤.01; and 4% vs 14%, P <.01, respectively). No difference in chronic GVHD, relapse, or nonrelapse mortality were found for PBSC or BM. The 2-year overall survival (OS) was 55% versus 56% (P =.57) and leukemia-free survival (LFS) was 49% versus 54% (P =.74) for BM and PBSC, respectively. On multivariate analysis, PBSC were associated with an increased risk of stage II-IV (hazard ratio [HR], 2.1; P <.001) and stage III-IV acute GVHD (HR, 3.8; P <.001). For LFS and OS, reduced intensity conditioning was the only factor associated with treatment failure (LFS: HR, 1.40; P =.04) and relapse (HR, 1.62; P =.02). CONCLUSION: In patients with acute leukemia in first or second remission receiving haploidentical transplantation with PT-Cy, the use of PBSC increases the risk of acute GVHD, whereas survival outcomes are comparable. Cancer 2018;124:1428-37.

AB - BACKGROUND: Incidence of graft-versus-host disease (GVHD) in haploidentical bone marrow (BM) transplants using posttransplantion cyclophosphamide (PT-Cy) is low, whereas GVHD using mobilized peripheral blood stem cells (PBSC) ranges between 30% and 40%. METHODS: To evaluate the effect of stem cell source in haploidentical transplantation with PT-Cy, we analyzed 451 patients transplanted for acute myeloid leukemia or acute lymphoblastic leukemia reported to the European Society for Blood and Marrow Transplantation. RESULTS: BM was used in 260 patients, and PBSC were used in 191 patients. The median follow-up was 21 months. Engraftment was lower in BM (92% vs 95%, P < 0.001). BM was associated with a lower incidence of stage II-IV and stage III-IV acute GVHD (21% vs 38%, P ≤.01; and 4% vs 14%, P <.01, respectively). No difference in chronic GVHD, relapse, or nonrelapse mortality were found for PBSC or BM. The 2-year overall survival (OS) was 55% versus 56% (P =.57) and leukemia-free survival (LFS) was 49% versus 54% (P =.74) for BM and PBSC, respectively. On multivariate analysis, PBSC were associated with an increased risk of stage II-IV (hazard ratio [HR], 2.1; P <.001) and stage III-IV acute GVHD (HR, 3.8; P <.001). For LFS and OS, reduced intensity conditioning was the only factor associated with treatment failure (LFS: HR, 1.40; P =.04) and relapse (HR, 1.62; P =.02). CONCLUSION: In patients with acute leukemia in first or second remission receiving haploidentical transplantation with PT-Cy, the use of PBSC increases the risk of acute GVHD, whereas survival outcomes are comparable. Cancer 2018;124:1428-37.

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