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Transplants Using Stem Cells From The Blood Or Bone Marrow Yield Similar Survival Rates In Blood Cancer Patients (ASH 2011)

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Published: Mar 6, 2012 9:42 am
Transplants Using Stem Cells From The Blood Or Bone Marrow Yield Similar Survival Rates In Blood Cancer Patients (ASH 2011)

For blood cancer patients receiving a stem cell transplant from an unrelated donor, survival rates appear to be similar regardless of whether the stem cells were collected from the blood or from the bone marrow, according to results from a recent randomized Phase 3 trial.

However, transplants using stem cells from the blood were associated with a higher rate of chronic graft-versus-host disease, a common transplant-related complication.

Dr. Claudio Anasetti of the Moffitt Cancer Center in Tampa, Florida, presented the findings at the 2011 American Society of Hematology (ASH) conference in San Diego in December.

In myelodysplastic syndromes (MDS), the bone marrow overproduces developing blood cells that are unable to properly mature into healthy, functioning cells.

The only potentially curative treatment currently available to MDS patients is a donor (allogeneic) stem cell transplant, in which the patient receives healthy stem cells from either a close relative or an unrelated donor whose cells closely match those of the patient.

Once a donor is selected, stem cells can be collected from either the donor’s peripheral (circulating) blood, or from the donor’s bone marrow. Either way, the patient’s own blood-forming cells are first destroyed by chemotherapy and radiation and later replaced by the stem cells from the blood or bone marrow of the donor.

Previous studies have shown that transplants using stem cells collected from the blood of sibling donors increased the risk of graft-versus-host disease, but decreased the risk of relapse and improved overall survival compared to transplants using the bone marrow of sibling donors.

In the present study, researchers compared two-year survival rates for 551 patients with various forms of blood cancers, including MDS, who received either a peripheral blood stem cell or bone marrow transplant from an unrelated donor between 2004 and 2009.

Almost half of the patients received chemotherapy with cyclophosphamide (Cytoxan) plus total body irradiation prior to their stem cell transplant. In addition, 71 percent of patients received treatment with Prograf (tacrolimus) and methotrexate as preventative therapy against graft-versus-host disease, a common complication in which the donor immune cells recognize the recipient’s cells as foreign and attack them.

The median patient follow-up time was 36 months.

The study authors found no statistically significant differences in survival outcomes for the two patient groups.

At two years, 47 percent of patients who received a transplant with peripheral blood stem cells were alive and disease free, compared to 44 percent of patients who received a bone marrow transplant.

The two-year overall survival rate was 52 percent for those transplanted with peripheral blood stem cells, compared to 48 percent for those transplanted with bone marrow.

In both groups, 28 percent of patients relapsed.

Chronic graft-versus-host disease, which develops at least 100 days after the transplant, was more common in patients receiving a peripheral blood stem cell transplant (53 percent versus 40 percent).

The primary causes of death in the peripheral blood stem cell transplant group were relapse (49 percent) and graft-versus-host disease (34 percent). In the bone marrow transplant group, 54 percent died from relapse, 22 percent from graft-versus-host disease, and 7 percent from graft failure.

The rates of death unrelated to relapse were almost identical between the two groups (26 percent and 27 percent, respectively).

For more information, please see abstract 1 at the ASH 2011 meeting website.

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