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Peripheral blood vs bone marrow as a source for allogeneic hematopoietic stem cell transplantation
Bone Marrow Transplantation
|September 1, 1999
Summary
Peripheral blood stem cells (PBSC) transplantation led to faster hematopoietic recovery and similar acute graft-versus-host disease (GVHD) rates compared to bone marrow (BM) transplantation in patients with hematological diseases.
Area of Science:
- Hematology
- Transplantation Immunology
Background:
- Allogeneic stem cell transplantation is a critical treatment for various hematological diseases.
- The choice of stem cell source, peripheral blood stem cells (PBSC) versus bone marrow (BM), impacts transplant outcomes.
- Graft-versus-host disease (GVHD) remains a significant complication following allogeneic transplantation.
Purpose of the Study:
- To compare the tempo of hematopoietic recovery between PBSC and BM as sources for allogeneic transplantation.
- To evaluate the incidence of acute graft-versus-host disease (GVHD) in patients receiving PBSC versus BM allografts.
- To assess the safety and efficacy of PBSCT versus BMT in patients with hematological malignancies and bone marrow failure syndromes.
Main Methods:
- A randomized prospective study involving 30 patients with hematological diseases undergoing allogeneic transplantation.
- Patients were divided into two groups: 15 receiving PBSC and 15 receiving BM.
- Key outcome measures included hematopoietic reconstitution (absolute neutrophil count, platelet count) and incidence of acute GVHD.
Main Results:
- PBSC transplantation demonstrated significantly faster hematopoietic reconstitution, evidenced by quicker achievement of absolute neutrophil count (ANC) >0.5 x 10(9)/l (log-rank P <0.0018) and platelet count >25 x 10(9)/l (log-rank P <0.0098).
- The incidence of acute GVHD was lower in the PBSC group (6.7%) compared to the BM group (46.7%), with a P-value of 0.013.
- Median nucleated cell count harvested was 1.3 x 10(10) for BM, while PBSC aphereses yielded a median of 4.4 x 10(6) CD34+/kg.
Conclusions:
- PBSC transplantation is associated with accelerated hematopoietic recovery compared to bone marrow transplantation.
- The incidence of acute GVHD following PBSCT is comparable to or potentially lower than that observed with BMT.
- PBSC represents a viable and effective alternative stem cell source for allogeneic transplantation in patients with hematological diseases.