BACKGROUND AND OBJECTIVES: Intensive chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) is a curative treatment option for patients with myelodysplastic syndromes (MDS). Peripheral blood (PB) HSCT was introduced in 1992 and PB has become the source of choice of autologous stem cells worldwide. Autologous PB stem cells result in faster hematopoietic recovery, but may be associated with a higher risk of relapse. DESIGN AND METHODS: We analyzed the data of 336 patients transplanted after 1992 with either bone marrow (BM) (n=104) or PB (n=232). RESULTS: Various factors had an impact on event-free survival in univariate analysis: age hazard ratio [HR]=1.1 per 10 years; p=0.12), source of stem cells (HR=1.2, p=0.22), interval between diagnosis and transplantation (HR=1.0 per month; p=0.87), and therapy-related vs primary disease (HR=0.5; p=0.002). In the multivariate Cox model, the event-free survival was not different after PB or BM HSCT with a HR of 0.93 (95% confidence interval of 0.67 - 1.30; p=0.67). The relapse risk after transplantation with stem cells from either source was similar with a HR of 1.1. A significant interaction (p=0.02) between age and the source of stem cells indicated a more favorable potential of autologous PB HSCT in young age groups. INTERPRETATION AND CONCLUSIONS: Autologous PB and BM HSCT result in equivalent outcomes. Therefore, given the more rapid hematopoietic recovery PB is the preferred source of stem cells.
BACKGROUND AND OBJECTIVES: Intensive chemotherapy followed by autologous hematopoietic stem cell transplantation (HSCT) is a curative treatment option for patients with myelodysplastic syndromes (MDS). Peripheral blood (PB) HSCT was introduced in 1992 and PB has become the source of choice of autologous stem cells worldwide. Autologous PB stem cells result in faster hematopoietic recovery, but may be associated with a higher risk of relapse. DESIGN AND METHODS: We analyzed the data of 336 patients transplanted after 1992 with either bone marrow (BM) (n=104) or PB (n=232). RESULTS: Various factors had an impact on event-free survival in univariate analysis: age hazard ratio [HR]=1.1 per 10 years; p=0.12), source of stem cells (HR=1.2, p=0.22), interval between diagnosis and transplantation (HR=1.0 per month; p=0.87), and therapy-related vs primary disease (HR=0.5; p=0.002). In the multivariate Cox model, the event-free survival was not different after PB or BM HSCT with a HR of 0.93 (95% confidence interval of 0.67 - 1.30; p=0.67). The relapse risk after transplantation with stem cells from either source was similar with a HR of 1.1. A significant interaction (p=0.02) between age and the source of stem cells indicated a more favorable potential of autologous PB HSCT in young age groups. INTERPRETATION AND CONCLUSIONS: Autologous PB and BM HSCT result in equivalent outcomes. Therefore, given the more rapid hematopoietic recovery PB is the preferred source of stem cells.
Authors: Rüdiger Hehlmann; David Grimwade; Bengt Simonsson; Jane Apperley; Michele Baccarani; Tiziano Barbui; Giovanni Barosi; Renato Bassan; Marie C Béné; Ute Berger; Thomas Büchner; Alan Burnett; Nicolas C P Cross; Theo J M de Witte; Hartmut Döhner; Hervé Dombret; Hermann Einsele; Georg Engelich; Robin Foà; Christa Fonatsch; Nicola Gökbuget; Elaine Gluckman; Alois Gratwohl; Francois Guilhot; Claudia Haferlach; Thorsten Haferlach; Michael Hallek; Jörg Hasford; Andreas Hochhaus; Dieter Hoelzer; Jean-Jaques Kiladjian; Boris Labar; Per Ljungman; Ulrich Mansmann; Dietger Niederwieser; Gert Ossenkoppele; José M Ribera; Harald Rieder; Hubert Serve; Petra Schrotz-King; Miguel A Sanz; Susanne Saussele Journal: Haematologica Date: 2010-11-03 Impact factor: 9.941