In a nutshell
This study aimed to evaluate the effect of stem cell source on haploidentical transplantation with post-transplantation cyclophosphamide (a chemotherapy) in patients with acute leukemia. This study concluded that the use of peripheral blood stem cells increases the risk of side effects for these patients.
Some background
Patients with acute leukemia (AL) often undergo a transplant as part of their treatment. The stem cells that are transplanted into the patient can come from different sources. Two types of transplants are haploidentical bone marrow (HBM) stem cell transplants and haploidentical mobilized peripheral blood stem cell (HPBSC) transplants.
Graft-versus-host disease (GVHD) is a complication of transplant. In GVHD, the transplanted cells see the body as foreign and attack it. The incidence of GVHD in patients who have undergone HBM transplants and used post transplantation cyclophosphamide (PT-Cy) is low. HBM transplants involve the patient receiving bone marrow from a matched donor. PT-Cy is a drug used to suppress the immune system and prevent GVHD.
The incidence of GVHD in patients who have undergone HPBSC transplant is between 30 and 40%. This type of transplant uses blood stem cells.
It was not known if the stem cell source would influence the outcomes for patients who underwent transplant.
Methods & findings
This study involved 451 patients with AL who received a transplant. 260 patients received HBM and 191 patients received PBSC. Patients were followed for 21 months.
The BM group had an engraftment rate of 92% compared to 95% for the PBSC group. Engraftment describes when the blood-forming cells received at transplant start to grow and produce new blood cells.
The BM group had 21% incidence of stage II-IV acute GVHD compared to 38% for the PBSC group. The BM group had a 4% incidence of stage III-IV acute GVHD compared to 14% for PBSC group.
There was no difference in chronic GVHD, relapse or non-relapse mortality between the groups. The BM group had an overall survival rate (time from treatment until death from any cause) of 55% compared to 56% for the PBSC group. The BM group had a leukemia free survival rate of 49% compared to 54% in the PBSC group.
The bottom line
This study concluded that the use of PBSC increases the risk of acute GVHD in AL patients who receive transplantation with PT-Cy when compared to the use of BM, but survival rates are similar.
What’s next?
Consult your physician about the most suitable transplant option.
Published By :
Cancer
Date :
Jan 23, 2018
