Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The . gov means it’s official. Federal government websites often end in VSports app下载. gov or . mil. Before sharing sensitive information, make sure you’re on a federal government site. .

Https

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. V体育官网.

Clinical Trial
. 2012 Oct 18;367(16):1487-96.
doi: 10.1056/NEJMoa1203517.

Peripheral-blood stem cells versus bone marrow from unrelated donors

Claudio Anasetti  1 , Brent R Logan, Stephanie J Lee, Edmund K Waller, Daniel J Weisdorf, John R Wingard, Corey S Cutler, Peter Westervelt, Ann Woolfrey, Stephen Couban, Gerhard Ehninger, Laura Johnston, Richard T Maziarz, Michael A Pulsipher, David L Porter, Shin Mineishi, John M McCarty, Shakila P Khan, Paolo Anderlini, William I Bensinger, Susan F Leitman, Scott D Rowley, Christopher Bredeson, Shelly L Carter, Mary M Horowitz, Dennis L Confer; Blood and Marrow Transplant Clinical Trials Network
Collaborators, Affiliations
Clinical Trial

Peripheral-blood stem cells versus bone marrow from unrelated donors

Claudio Anasetti et al. N Engl J Med. .

Abstract

Background: Randomized trials have shown that the transplantation of filgrastim-mobilized peripheral-blood stem cells from HLA-identical siblings accelerates engraftment but increases the risks of acute and chronic graft-versus-host disease (GVHD), as compared with the transplantation of bone marrow. Some studies have also shown that peripheral-blood stem cells are associated with a decreased rate of relapse and improved survival among recipients with high-risk leukemia VSports手机版. .

Methods: We conducted a phase 3, multicenter, randomized trial of transplantation of peripheral-blood stem cells versus bone marrow from unrelated donors to compare 2-year survival probabilities with the use of an intention-to-treat analysis V体育安卓版. Between March 2004 and September 2009, we enrolled 551 patients at 48 centers. Patients were randomly assigned in a 1:1 ratio to peripheral-blood stem-cell or bone marrow transplantation, stratified according to transplantation center and disease risk. The median follow-up of surviving patients was 36 months (interquartile range, 30 to 37). .

Results: The overall survival rate at 2 years in the peripheral-blood group was 51% (95% confidence interval [CI], 45 to 57), as compared with 46% (95% CI, 40 to 52) in the bone marrow group (P=0. 29), with an absolute difference of 5 percentage points (95% CI, -3 to 14). The overall incidence of graft failure in the peripheral-blood group was 3% (95% CI, 1 to 5), versus 9% (95% CI, 6 to 13) in the bone marrow group (P=0. 002). The incidence of chronic GVHD at 2 years in the peripheral-blood group was 53% (95% CI, 45 to 61), as compared with 41% (95% CI, 34 to 48) in the bone marrow group (P=0. 01). There were no significant between-group differences in the incidence of acute GVHD or relapse V体育ios版. .

Conclusions: We did not detect significant survival differences between peripheral-blood stem-cell and bone marrow transplantation from unrelated donors. Exploratory analyses of secondary end points indicated that peripheral-blood stem cells may reduce the risk of graft failure, whereas bone marrow may reduce the risk of chronic GVHD. (Funded by the National Heart, Lung, and Blood Institute-National Cancer Institute and others; ClinicalTrials. gov number, NCT00075816 VSports最新版本. ). .

PubMed Disclaimer

Figures

Figure 1
Figure 1. Survival after Randomization in the Intention-to-Treat Analysis
The P value is from a stratified binomial comparison at the 2-year point. The P value from a stratified log-rank test was also not significant. A total of 75 patients in each group were still alive at 36 months.
Figure 2
Figure 2. Outcomes after Transplantation, According to Study Group
Panel A shows the rate of overall survival, and Panel B the rate of disease-free survival. Panel C shows the incidence of death unrelated to relapse. Panel D shows the incidence of relapse. Panel E shows the incidence of neutrophil engraftment (>500 neutrophils per cubic millimeter), and Panel F the incidence of platelet engraftment (>20,000 platelets per cubic millimeter, without platelet transfusion during the prior 7 days). Panel G shows the incidence of acute graft-versus-host disease (GVHD) of grades II to IV, and Panel H the incidence of chronic GVHD. P values for the between-group differences in overall survival (Panel A) and disease-free survival (Panel B) are from a stratified binomial comparison at the 2-year point; P values from stratified log-rank tests for survival and disease-free survival were also not significant. All other P values shown are from stratified log-rank tests.
See this image and copyright information in PMC

Comment in (VSports注册入口)

References

    1. Russell NH, Hunter A, Rogers S, Hanley J, Anderson D. Peripheral blood stem cells as an alternative to marrow for allogeneic transplantation. Lancet. 1993;341:1482. - PubMed (V体育平台登录)
    1. Dreger P, Suttorp M, Haferlach T, Löffler H, Schmitz N, Schroyens W. Allogeneic granulocyte colony-stimulating factor-mobilized peripheral blood progenitor cells for treatment of engraftment failure after bone marrow transplantation. Blood. 1993;81:1404–7. - PubMed
    1. Körbling M, Przepiorka D, Huh YO, et al. Allogeneic blood stem cell transplantation for refractory leukemia and lymphoma: potential advantage of blood over marrow allografts. Blood. 1995;85:1659–65. - PubMed
    1. Schmitz N, Dreger P, Suttorp M, et al. Primary transplantation of allogeneic peripheral blood progenitor cells mobilized by filgrastim (granulocyte colony-stimulating factor) Blood. 1995;85:1666–72. - PubMed
    1. Bensinger WI, Weaver CH, Appelbaum FR, et al. Transplantation of allogeneic peripheral blood stem cells mobilized by recombinant human granulocyte colony-stimulating factor. Blood. 1995;85:1655–8. - PubMed (V体育官网)

Publication types

MeSH terms

Associated data