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Peripheral blood stem cell and bone marrow survival rates even in unrelated donor transplants

Relapse rates, non-relapse mortality and acute graft-versus-host disease (GHVD) also appear unaffected.

The goal of the trial was to determine whether graft source affects outcome in unrelated donor transplants for patients with leukemia or other hematologic malignancies. Fifty transplant centers throughout North America participated in the phase III study, which randomized 278 patients to receive bone marrow and 273 patients to receive peripheral blood stem cells as the graft source for transplant. Peripheral blood stem cells originate in the bone marrow, but are pushed into the blood stream using a special drug regimen where they are collected for transplantation.

While engraftment was faster in those treated with peripheral blood stem cells, a higher incidence of overall chronic GVHD occurred in these patients than in those transplanted with bone marrow stem cells (53 percent vs. 40 percent). Patients receiving peripheral cells from unrelated donors also had a higher incidence of chronic GVHD affecting multiple organs than those treated with bone marrow stem cells (46 percent vs. 31 percent).

Claudio Anasetti, M.D., chair of the Department of Blood & Marrow Transplant at Moffitt Cancer Center in Tampa, Fla., was the study’s lead author. Their work is published in the Oct. 18 issue of the New England Journal of Medicine.

"Although peripheral blood stem cells from related donors have demonstrated clinical benefits, our trial demonstrates that when these stem cells originate from unrelated donors, they are not superior to bone marrow stem cells in terms of patient survival, and they increase the risk for chronic GVHD," Dr. Anasetti said. "More effective strategies to prevent GVHD are needed to improve outcomes for all patients receiving unrelated donor transplants."

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