PURPOSE: Controversy exists as to whether the incidence of graft-versus-host disease (GVHD) is increased after peripheral-blood stem-cell transplantation (PBSCT) when compared with bone marrow transplantation (BMT). We performed a meta-analysis of all trials comparing the incidence of acute and chronic GVHD after PBSCT and BMT reported as of June, 2000. Secondary analyses examined relapse rates after the two procedures. METHODS: An extensive MEDLINE search of the literature was undertaken. Primary authors were contacted for clarification and completion of missing information. A review of cited references was also undertaken. Sixteen studies (five randomized controlled trials and 11 cohort studies) were included in this analysis. Data was extracted by two pairs of reviewers and analyzed for the outcomes of interest. Meta-analyses, regression analyses, and assessments of publication bias were performed. RESULTS: Using a random effects model, the pooled relative risk (RR) for acute GVHD after PBSCT was 1.16 (95% confidence interval [CI], 1.04 to 1.28; P=.006) when compared with traditional BMT. The pooled RR for chronic GVHD after PBSCT was 1.53 (95% CI, 1.25 to 1.88; P <.001) when compared with BMT. The RR of developing clinically extensive chronic GVHD was 1.66 (95% CI, 1.35 to 2.05; P <.001). The excess risk of chronic GVHD was explained by differences in the T-cell dose delivered with the graft in a meta-regression model that did not reach statistical significance. There was a trend towards a decrease in the rate of relapse after PBSCT (RR = 0.81; 95% CI, 0.62 to 1.05). CONCLUSION: Both acute and chronic GVHD are more common after PBSCT than BMT, and this may be associated with lower rates of malignant relapse. The magnitude of the transfused T-cell load may explain the differences in chronic GVHD risk.
PURPOSE: Controversy exists as to whether the incidence of graft-versus-host disease (GVHD) is increased after peripheral-blood stem-cell transplantation (PBSCT) when compared with bone marrow transplantation (BMT). We performed a meta-analysis of all trials comparing the incidence of acute and chronic GVHD after PBSCT and BMT reported as of June, 2000. Secondary analyses examined relapse rates after the two procedures. METHODS: An extensive MEDLINE search of the literature was undertaken. Primary authors were contacted for clarification and completion of missing information. A review of cited references was also undertaken. Sixteen studies (five randomized controlled trials and 11 cohort studies) were included in this analysis. Data was extracted by two pairs of reviewers and analyzed for the outcomes of interest. Meta-analyses, regression analyses, and assessments of publication bias were performed. RESULTS: Using a random effects model, the pooled relative risk (RR) for acute GVHD after PBSCT was 1.16 (95% confidence interval [CI], 1.04 to 1.28; P=.006) when compared with traditional BMT. The pooled RR for chronic GVHD after PBSCT was 1.53 (95% CI, 1.25 to 1.88; P <.001) when compared with BMT. The RR of developing clinically extensive chronic GVHD was 1.66 (95% CI, 1.35 to 2.05; P <.001). The excess risk of chronic GVHD was explained by differences in the T-cell dose delivered with the graft in a meta-regression model that did not reach statistical significance. There was a trend towards a decrease in the rate of relapse after PBSCT (RR = 0.81; 95% CI, 0.62 to 1.05). CONCLUSION: Both acute and chronic GVHD are more common after PBSCT than BMT, and this may be associated with lower rates of malignant relapse. The magnitude of the transfused T-cell load may explain the differences in chronic GVHD risk.
Authors: M Y Detrait; S Morisset; R Peffault de Latour; I Yakoub-Agha; R Crocchiolo; R Tabrizi; J-O Bay; P Chevalier; F Barraco; N Raus; S Vigouroux; L Magro; M Mohty; N Milpied; D Blaise; G Socié; M Michallet Journal: Bone Marrow Transplant Date: 2014-11-03 Impact factor: 5.483
Authors: Marco Mielcarek; Barry Storer; Paul J Martin; Stephen J Forman; Robert S Negrin; Mary E Flowers; Yoshihiro Inamoto; Thomas R Chauncey; Rainer Storb; Frederick R Appelbaum; William I Bensinger Journal: Blood Date: 2012-02-03 Impact factor: 22.113
Authors: Yoshihiro Inamoto; Mary E D Flowers; Frederick R Appelbaum; Paul A Carpenter; H Joachim Deeg; Terry Furlong; Hans-Peter Kiem; Marco Mielcarek; Richard A Nash; Rainer F Storb; Robert P Witherspoon; Barry E Storer; Paul J Martin Journal: Biol Blood Marrow Transplant Date: 2011-03-21 Impact factor: 5.742
Authors: Norbert Schmitz; Mary Eapen; Mary M Horowitz; Mei-Jie Zhang; John P Klein; J Douglas Rizzo; Fausto R Loberiza; Alois Gratwohl; Richard E Champlin Journal: Blood Date: 2006-08-31 Impact factor: 22.113
Authors: Christopher J Fraser; Smita Bhatia; Kirsten Ness; Andrea Carter; Liton Francisco; Mukta Arora; Pablo Parker; Stephen Forman; Daniel Weisdorf; James G Gurney; K Scott Baker Journal: Blood Date: 2006-06-20 Impact factor: 22.113