Characteristics of patients given marrow as compared with those given blood as the source of hematopoietic cells for transplantation
| . | Patients given marrow (n = 60) . | Patients given blood (n = 55) . | P . |
|---|---|---|---|
| Patients' median (range) age at Tx, y | 43 (22-56) | 43 (15-56) | .57 |
| Donors' median (range) age at Tx, y | 41 (18-65) | 40 (13-63) | .34 |
| Patients' sex (M/F) | 39/21 | 35/20 | .97 |
| Donors' sex (M/F) | 32/28 | 31/24 | .89 |
| Donor-patient histocompatibility | |||
| HLA-A, B, and DR-matched sibling | 60 (100) | 54 (98) | .97 |
| HLA-A, B, and DR-matched child | 0 (0) | 1 (2) | |
| Disease/disease stage at Tx* | |||
| Good risk | 34 (57) | 31 (56) | .88 |
| Poor risk | 26 (43) | 24 (44) | |
| First Tx | 60 (100) | 55 (100) | 1.00 |
| CMV serostatus before Tx | |||
| Donor positive/recipient positive | 22 (37) | 15 (27) | .63 |
| Donor negative/recipient positive | 11 (18) | 14 (25) | |
| Donor positive/recipient negative | 10 (17) | 11 (20) | |
| Donor negative/recipient negative | 17 (28) | 14 (25) | |
| Unknown or equivocal | 0 (0) | 1 (2) | |
| HSV serostatus before Tx | |||
| Patient positive | 44 (73) | 35 (64) | .73 |
| Patient negative | 11 (18) | 14 (25) | |
| Unknown or equivocal | 5 (8) | 6 (11) | |
| VZV serostatus before Tx | |||
| Patient positive | 58 (97) | 53 (96) | .45 |
| Patient negative | 0 (0) | 2 (4) | |
| Unknown or equivocal | 2 (3) | 0 (0) | |
| Patients with splenectomy | 3 (5) | 1 (2) | .67 |
| Myeloablative conditioning | |||
| Chemotherapy only | 30 (50) | 27 (49) | .33 |
| Chemotherapy and total-body irradiation | 29 (48) | 24 (44) | |
| Chemotherapy and total-marrow irradiation | 1 (2) | 4 (7) | |
| GVHD prophylaxis with methotrexate (day 1, 3, 6, and 11) and cyclosporine (daily for 6 months)58 | 60 (100) | 55 (100) | 1.00 |
| Acute GVHD | |||
| Grade 0-1 | 16 (27) | 16 (29) | .94 |
| Grade 2-4† | 44 (73) | 39 (71) | |
| Chronic GVHD diagnosed by day 365 | |||
| None or clinically limited | 25 (42) | 18 (33) | .16 |
| Clinically extensive‡ | 23 (38) | 32 (58) | |
| Not applicable (relapse or death before day 100) | 12 (20) | 5 (9) | |
| Chimerism status | |||
| Full chimera (≥ 90% marrow cells of donor origin by day 80) | 52 (87) | 47 (85) | 1.00 |
| Unknown | 8 (13) | 8 (15) | |
| Median (range) day of neutrophil engraftment (> 0.5 × 109/L) | 20 (18-28) | 16 (11-28) | < .01 |
| Neutropenia (< 0.5 × 109/L) between day 30 day and 3651-153 | 7 (12) | 4 (7) | .63 |
| Relapse between day 30 and day 3651-155 | 8 (13) | 8 (15) | .94 |
| Death without relapse between day 30 and day 365 | 18 (30) | 6 (11) | .02 |
| Glucocorticoid treatment between day 30 and day 365 | 51 (86) | 45 (82) | .84 |
| CMV prophylaxis | |||
| Ganciclovir if pp65-antigenemia positive59 | 53 (88) | 51 (93) | .63 |
| Infusion of ex vivo–expanded CMV-specific T cells601-154 | 7 (12) | 4 (7) | |
| Viral prophylaxis with acyclovir/valacyclovir/famciclovir beyond standard1-159 | |||
| Yes | 22 (37) | 14 (25) | .20 |
| No | 33 (55) | 39 (71) | |
| Unknown | 5 (8) | 2 (4) | |
| Bacterial/Pneumocystis/fungal prophylaxis with sulfamethoxazole and trimethoprim and/or fluconazole/itraconazole beyond standard*,* | |||
| Yes | 24 (40) | 29 (53) | .46 |
| No | 19 (32) | 15 (27) | |
| Not applicable (early relapse or death) or unknown | 17 (28) | 11 (20) | |
| Prophylaxis with intravenous immunoglobulin†,† | 8 (13) | 6 (11) | .91 |
| . | Patients given marrow (n = 60) . | Patients given blood (n = 55) . | P . |
|---|---|---|---|
| Patients' median (range) age at Tx, y | 43 (22-56) | 43 (15-56) | .57 |
| Donors' median (range) age at Tx, y | 41 (18-65) | 40 (13-63) | .34 |
| Patients' sex (M/F) | 39/21 | 35/20 | .97 |
| Donors' sex (M/F) | 32/28 | 31/24 | .89 |
| Donor-patient histocompatibility | |||
| HLA-A, B, and DR-matched sibling | 60 (100) | 54 (98) | .97 |
| HLA-A, B, and DR-matched child | 0 (0) | 1 (2) | |
| Disease/disease stage at Tx* | |||
| Good risk | 34 (57) | 31 (56) | .88 |
| Poor risk | 26 (43) | 24 (44) | |
| First Tx | 60 (100) | 55 (100) | 1.00 |
| CMV serostatus before Tx | |||
| Donor positive/recipient positive | 22 (37) | 15 (27) | .63 |
| Donor negative/recipient positive | 11 (18) | 14 (25) | |
| Donor positive/recipient negative | 10 (17) | 11 (20) | |
| Donor negative/recipient negative | 17 (28) | 14 (25) | |
| Unknown or equivocal | 0 (0) | 1 (2) | |
| HSV serostatus before Tx | |||
| Patient positive | 44 (73) | 35 (64) | .73 |
| Patient negative | 11 (18) | 14 (25) | |
| Unknown or equivocal | 5 (8) | 6 (11) | |
| VZV serostatus before Tx | |||
| Patient positive | 58 (97) | 53 (96) | .45 |
| Patient negative | 0 (0) | 2 (4) | |
| Unknown or equivocal | 2 (3) | 0 (0) | |
| Patients with splenectomy | 3 (5) | 1 (2) | .67 |
| Myeloablative conditioning | |||
| Chemotherapy only | 30 (50) | 27 (49) | .33 |
| Chemotherapy and total-body irradiation | 29 (48) | 24 (44) | |
| Chemotherapy and total-marrow irradiation | 1 (2) | 4 (7) | |
| GVHD prophylaxis with methotrexate (day 1, 3, 6, and 11) and cyclosporine (daily for 6 months)58 | 60 (100) | 55 (100) | 1.00 |
| Acute GVHD | |||
| Grade 0-1 | 16 (27) | 16 (29) | .94 |
| Grade 2-4† | 44 (73) | 39 (71) | |
| Chronic GVHD diagnosed by day 365 | |||
| None or clinically limited | 25 (42) | 18 (33) | .16 |
| Clinically extensive‡ | 23 (38) | 32 (58) | |
| Not applicable (relapse or death before day 100) | 12 (20) | 5 (9) | |
| Chimerism status | |||
| Full chimera (≥ 90% marrow cells of donor origin by day 80) | 52 (87) | 47 (85) | 1.00 |
| Unknown | 8 (13) | 8 (15) | |
| Median (range) day of neutrophil engraftment (> 0.5 × 109/L) | 20 (18-28) | 16 (11-28) | < .01 |
| Neutropenia (< 0.5 × 109/L) between day 30 day and 3651-153 | 7 (12) | 4 (7) | .63 |
| Relapse between day 30 and day 3651-155 | 8 (13) | 8 (15) | .94 |
| Death without relapse between day 30 and day 365 | 18 (30) | 6 (11) | .02 |
| Glucocorticoid treatment between day 30 and day 365 | 51 (86) | 45 (82) | .84 |
| CMV prophylaxis | |||
| Ganciclovir if pp65-antigenemia positive59 | 53 (88) | 51 (93) | .63 |
| Infusion of ex vivo–expanded CMV-specific T cells601-154 | 7 (12) | 4 (7) | |
| Viral prophylaxis with acyclovir/valacyclovir/famciclovir beyond standard1-159 | |||
| Yes | 22 (37) | 14 (25) | .20 |
| No | 33 (55) | 39 (71) | |
| Unknown | 5 (8) | 2 (4) | |
| Bacterial/Pneumocystis/fungal prophylaxis with sulfamethoxazole and trimethoprim and/or fluconazole/itraconazole beyond standard*,* | |||
| Yes | 24 (40) | 29 (53) | .46 |
| No | 19 (32) | 15 (27) | |
| Not applicable (early relapse or death) or unknown | 17 (28) | 11 (20) | |
| Prophylaxis with intravenous immunoglobulin†,† | 8 (13) | 6 (11) | .91 |
Values are numbers (percentages) of patients unless otherwise indicated. The significance of differences between patients given marrow and those given blood stem cells was assessed by eithert test (age and neutrophil engraftment) or χ2 square test (all other variables).
Tx indicates transplantation; CMV, cytomegalovirus; HSV, herpes simplex virus; VZV, varicella zoster virus; GVHD, graft-versus-host disease.
Good risk was defined as the presence of chronic myelogenous leukemia (CML) in first chronic or accelerated phase, acute leukemia in first remission, refractory anemia, or myelofibrosis. Poor risk was defined as the presence of CML in blast crisis, acute leukemia beyond first remission, refractory anemia with excess blasts, lymphoma, or multiple myeloma.
Typically treated with prednisone (1-2 mg/kg per day given orally for 10 to 14 days with subsequent tapering during 50 days).
Typically treated with prednisone (0.5-1.0 mg/kg given orally every other day) and cyclosporine (approximately 6 mg/kg given orally every other day) for at least 9 months.
Values are numbers of episodes. There was one episode per patient. No episode was due to graft rejection. Episodes were typically associated with a viral infection and lasted for several days.
For patients with CML, detection of bcr/abl transcript by polymerase chain reaction in the absence of cytogenetic or hematologic relapse was not considered a relapse.
Values were typically 1 × 109 CD4 cells/m2 and 2 × 109 CD8 cells/m2 of body-surface area.
According to standard practice, all patients seropositive for herpes simplex virus received acyclovir (800 mg twice a day given orally) during the first month only. Some patients or physicians chose prophylaxis with acyclovir, valacyclovir, or famciclovir between day 30 and day 365 after transplantation; the patients are included here.
According to standard practice, all patients received prophylactic sulfamethoxazole and trimethoprim until day 180 after transplantation (800 mg sulfamethoxazole and 160 mg trimethoprim given orally twice a day every Monday and Tuesday) and fluconazole until day 75 (400 mg given orally every day). Itraconazole was given instead of fluconazole to 5 marrow recipients and 2 blood stem cell recipients. After the end of the routine bacterial/Pneumocystis/fungal prophylaxis, some patients or physicians chose to continue prophylactic therapy; the patients are counted here. Typically, these were patients with clinically extensive chronic GVHD who were treated with immunosuppressive drugs, sulfamethoxazole and trimethoprim (800 mg and 160 mg, respectively, given orally twice a day every Monday and Tuesday), penicillin (500 mg given orally twice a day every day), and rarely, fluconazole or itraconazole.
Typically, 200 mg/kg was given weekly before day 100 after transplantation, and 500 mg/kg was given monthly after day 100.