Should bone marrow or peripheral blood be used for hematopoietic cell transplantation from unrelated donors?
In this follow-up of a randomized clinical trial, recipients of unrelated donor bone marrow had the same 5-year survival with better psychological well-being, less burdensome chronic graft-vs-host disease symptoms, and a higher likelihood of returning to work than recipients of peripheral blood.
Bone marrow should be used instead of peripheral blood for unrelated donor transplantation when calcineurin inhibitor/methotrexate-based graft-vs-host disease prophylaxis is used.
Bone marrow or peripheral blood from unrelated donors may be used for hematopoietic cell transplantation. Information about the relative success of transplantation with these 2 graft sources would help physicians and patients choose between them.
To compare patient-reported outcomes between patients randomized to receive 1 of 2 graft types for unrelated donor transplantation.
Design, Setting, and Participants
This follow-up of a randomized clinical trial included English- or Spanish-speaking patients 16 years or older participating in a multicenter randomized clinical trial of unrelated donor bone marrow (BM) vs peripheral blood (PB) (N = 551) in hematopoietic cell transplantation for hematologic neoplasms. Patient-reported outcomes were collected from patients at enrollment and 0.5, 1, 2, and 5 years after transplantation.
Unrelated donor BM or PB hematopoietic cell transplantation.
Main Outcomes and Measures
Functional Assessment of Cancer Therapy–Bone Marrow Transplant, Mental Health Inventory, occupational functioning, Lee Chronic Graft-vs-Host Disease Symptom Scale.
At 5 years after transplantation, 102 BM and 93 PB participants were alive and eligible for assessment (age ≥40 years or older: 104 [53.5%] male: 101 [51.8%]). The mean (SE) Mental Health Inventory Psychological Well-Being scores (78.9 [1.7] vs 72.2 [1.9]; P = .01; higher better) and Lee chronic graft-vs-host disease symptom scores (13.1 [1.5] vs 19.3 [1.6]; P = .004; lower better) were significantly better for BM recipients, adjusting for baseline scores and missing data. Recipients of BM were also more likely to be working full or part-time than recipients of PB (odds ratio, 1.5; 95% CI, 1.2-2.0; P = .002), adjusting for work status before transplantation. With a median follow-up of 73 months (range, 30-121 months) for survivors, no differences in survival (40% vs 39%; P = .84), relapse (32% vs 29%; P = .47), or treatment-related mortality (29% vs 32%; P = .44) between BM and PB were observed.
Conclusions and Relevance
Recipients of unrelated donor BM had better psychological well-being, less burdensome chronic GVHD symptoms, and were more likely to return to work than recipients of PB at 5 years after transplantation. Bone marrow should be the standard of care for these types of transplant procedures.
clinicaltrials.gov Identifier: NCT00075816
Lee SJ, Logan B, Westervelt P, et al. Comparison of Patient-Reported Outcomes in 5-Year Survivors Who Received Bone Marrow vs Peripheral Blood Unrelated Donor Transplantation: Long-term Follow-up of a Randomized Clinical Trial. JAMA Oncol. 2016;2(12):1583–1589. doi:10.1001/jamaoncol.2016.2520
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