Filgrastim-Stimulated Bone Marrow Compared with Filgrastim-Mobilized Peripheral Blood in Myeloablative Sibling Allografting for Patients with Hematologic Malignancies: A Randomized Canadian Blood and Marrow Transplant Group Study Academic Article uri icon

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abstract

  • In adult hematopoietic cell transplantation (HCT), filgrastim-mobilized peripheral blood (G-PB) has largely replaced unstimulated marrow for allografting. Although the use of G-PB results in faster hematopoietic recovery, it is also associated with more chronic graft-versus-host disease (cGVHD). A potential alternative allograft is filgrastim-stimulated marrow (G-BM), which we hypothesized may be associated with prompt hematopoietic recovery but with less cGVHD. We conducted a phase 3, open-label, multicenter randomized trial of 230 adults with hematologic malignancies receiving allografts from siblings after myeloablative conditioning to compare G-PB with G-BM. The primary endpoint was time to treatment failure, defined as a composite of extensive cGVHD, relapse/disease progression, and death. With a median follow-up of 36 months (range, 9.6 to 48), comparing G-BM with G-PB, there was no difference between the 2 arms with respect to the primary outcome of this study (hazard ratio [HR], .91; 95% confidence interval [CI], .68 to 1.22; P = .52). However, the cumulative incidence of overall cGVHD was lower with G-BM (HR, .66; 95% CI, .46 to .95; P = .007) and there was no difference in the risk of relapse or progression (P = .35). The median times to neutrophil recovery (P = .0004) and platelet recovery (P = .012) were 3 days shorter for recipients allocated to G-PB compared with those allocated to G-BM, but there were no differences in secondary engraftment-related outcomes, such as time to first hospital discharge (P = .17). In addition, there were no graft failures in either arm. This trial demonstrates that, compared with G-PB, the use of G-BM allografts leads to a significantly lower rate of overall cGVHD without a loss of the graft-versus-tumor effect and comparable overall survival. Our findings suggest that further study of this type of allograft is warranted.

authors

  • Couban, Stephen
  • Aljurf, Mahmoud
  • Lachance, Sylvie
  • Walker, Irwin Ronald
  • Toze, Cynthia
  • Rubinger, Morel
  • Lipton, Jeffrey H
  • Lee, Stephanie J
  • Szer, Jeff
  • Doocey, Richard
  • Lewis, Ian D
  • Huebsch, Lothar
  • Howson-Jan, Kang
  • Lalancette, Michel
  • Almohareb, Fahad
  • Chaudhri, Nadeem
  • Ivison, Sabine
  • Broady, Raewyn
  • Levings, Megan
  • Fairclough, Diane
  • Devins, Gerald
  • Szwajcer, David
  • Foley, Ronan
  • Smith, Clayton
  • Panzarella, Tony
  • Kerr, Holly
  • Kariminia, Amina
  • Schultz, Kirk R

publication date

  • August 2016

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