Transplantation of Peripheral Blood Cells As Compared with Bone Marrow From HLA-Identical Related Donors Is Associated with Superior Long-Term Outcomes

Our follow-up analysis showed sustained protection against recurrent malignancy associated with the use of PBSC compared with BM (Figure 1). The estimated 10-year probability of relapse was 20% with PBSC and 32% with BM (adjusted hazard ratio [HR] for BM versus PBSC, 2.22; 95% confidence interval [CI], 1.2–4.1; p=0.01). In contrast to the earlier analysis, the hazard of overall mortality for all patients was not significantly different between the two groups. However, there was a trend toward superior overall survival associated with use of PBSC, which was attributable to increased mortality with use of BM in the subgroup of patients with high-risk cancers (n=80; HR, 1.42; 95% CI, 0.8–2.5; p=0.21). The 2-year cumulative incidence of chronic GVHD requiring systemic immunosuppressive treatment was 48% with PBSC and 37% with BM (HR, 0.86; 95% CI, 0.5–1.4; p=0.55). We found no evidence that the use of PBSC prolonged the duration of systemic immunosuppressive treatment among patients with chronic GVHD (HR, 1.21; 95% CI, 0.6–2.6; p=0.64). In conclusion, among patients who had hematologic malignancies treated with myeloablative conditioning and hematopoietic cell transplantation from HLA-identical sibling donors, the use of PBSC conferred greater long-term protection against recurrent malignancy than BM without causing excess chronic GVHD-related mortality.