TY - JOUR
T1 - Filgrastim-Stimulated Bone Marrow Compared with Filgrastim-Mobilized Peripheral Blood in Myeloablative Sibling Allografting for Patients with Hematologic Malignancies
T2 - A Randomized Canadian Blood and Marrow Transplant Group Study
AU - Couban, Stephen
AU - Aljurf, Mahmoud
AU - Lachance, Sylvie
AU - Walker, Irwin
AU - Toze, Cynthia
AU - Rubinger, Morel
AU - Lipton, Jeffrey H.
AU - Lee, Stephanie J.
AU - Szer, Richard
AU - Doocey, R.
AU - Lewis, Ian D.
AU - Huebsch, Lothar
AU - Howson-Jan, Kang
AU - Lalancette, Michel
AU - Almohareb, Fahad
AU - Chaudhri, Nadeem
AU - Ivison, Sabine
AU - Broady, Raewyn
AU - Levings, Megan
AU - Fairclough, Diane
AU - Devins, Gerald
AU - Szwajcer, David
AU - Foley, Ronan
AU - Smith, Clayton
AU - Panzarella, Tony
AU - Kerr, Holly
AU - Kariminia, Amina
AU - Schultz, Kirk R.
N1 - Funding Information:
Financial disclosure statement: This study was undertaken by the CBMTG and funded by a grant from the United States National Cancer Institute (Principal Investigator: K.R.S., grant no. 1R01CA108752-01A2 ) and CBMTG (grant no. 0601 ).
Publisher Copyright:
© 2016 American Society for Blood and Marrow Transplantation
PY - 2016/8/1
Y1 - 2016/8/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.bbmt.2016.04.017
DO - 10.1016/j.bbmt.2016.04.017
M3 - Article
C2 - 27154847
AN - SCOPUS:84981340618
SN - 1083-8791
VL - 22
SP - 1410
EP - 1415
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 8
ER -