Comparison of outcomes after transplantation of g-csf-stimulated bone marrow grafts versus bone marrow or peripheral blood grafts from hla-matched sibling donors for patients with severe aplastic anemia

Roland Chu, Ruta Brazauskas, Fangyu Kan, Asad Bashey, Christopher Bredeson, Bruce Camitta, Kuang Yueh Chiang, Haydar Frangoul, Robert Peter Gale, Adrian Gee, Biju George, Frederick D. Goldman, Thomas G. Gross, Vikas Gupta, Gregory A. Hale, Luis Isola, Alvaro Urbano Ispizua, Hillard Lazarus, Judith Marsh, James RussellMitchell Sabloff, Edmund K. Waller, Mary Eapen

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47 Scopus citations

Abstract

We compared outcomes of patients with severe aplastic anemia (SAA) who received granulocyte-colony stimulating factor (G-CSF)-stimulated bone marrow (G-BM) (n = 78), unstimulated bone marrow (BM) (n = 547), or peripheral blood progenitor cells (PBPC) (n = 134) from an HLA-matched sibling. Transplantations occurred in 1997 to 2003. Rates of neutrophil and platelet recovery were not different among the 3 treatment groups. Grade 2-4 acute graft-versus-host disease (aGVHD) (relative risk [RR] = 0.82, P = .539), grade 3-4 aGVHD (RR = 0.74, P = .535), and chronic GVHD (cGVHD) (RR = 1.56, P = .229) were similar after G-BM and BM transplants. Grade 2-4 aGVHD (RR = 2.37, P = .012) but not grade 3-4 aGVHD (RR = 1.66, P = .323) and cGVHD (RR = 5.09, P < .001) were higher after PBPC transplants compared to G-BM. Grade 2-4 (RR = 2.90, P < .001), grade 3-4 (RR = 2.24, P = .009) aGVHD and cGVHD (RR = 3.26, P < .001) were higher after PBPC transplants compared to BM. Mortality risks were lower after transplantation of BM compared to G-BM (RR = 0.63, P = .05). These data suggest no advantage to using G-BM and the observed higher rates of aGVHD and cGVHD in PBPC recipients warrants cautious use of this graft source for SAA. Taken together, BM is the preferred graft for HLA-matched sibling transplants for SAA.

Original languageEnglish
Pages (from-to)1018-1024
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume17
Issue number7
DOIs
StatePublished - Jul 2011

Keywords

  • Aplastic anemia
  • G-mobilized BM
  • GVHD
  • Survival

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