Filgrastim-mobilized Peripheral Blood Progenitor Cells Versus Bone Marrow Transplantation for Treating Leukemia: 3-year Results from the EBMT Randomized Trial

Background And Objectives: Allogeneic peripheral blood progenitor cells (PBPC) are now widely used as the source of hematopoietic stem cells for transplantation. However, it is still not clear which patients should receive mobilized PBPC or bone marrow cells to reconstitute hematopoiesis after myeloablative conditioning. The aim of this study is to present 3-year-follow-up data on outcome (incidence and severity of chronic graft-versus-host disease (GVHD), overall survival (OS) and leukemia-free survival (LFS) after a PBPC transplant (PBPCT) or a bone marrow transplant (BMT).

Design And Methods: Data on 350 patients with leukemia were collected in a multicenter, randomized study initiated by the EBMT. The patients were randomized to receive filgrastim-mobilized PBSCT or BMT from an HLA-identical donor.

Results: At a median follow-up of 3 years, significantly more patients transplanted with PBPC than with bone marrow developed chronic GVHD (73% vs 55%, p=0.003) and extensive chronic GvHD (36% vs 19%, p=0.002). The higher incidence and greater severity of chronic GvHD had little impact on the patient's performance status or survival. OS was 58% for PBPCT recipients versus 65% among those undergoing BMT. LFS was 56% for PBPCT recipients versus 60% for BMT recipients.

Interpretation And Conclusions: Patients transplanted with PBPC from an HLA-identical sibling develop more chronic GvHD than those transplanted with bone marrow, but the final impact of this difference is unclear. Longer follow-up is necessary to characterize the impact of chronic GvHD on quality of life, leukemia-free survival and overall survival.