TY - JOUR
T1 - Allogeneic peripheral blood stem-cell compared with bone marrow transplantation in the management of hematologic malignancies
T2 - An individual patient data meta-analysis of nine randomized trials
AU - Al-Jurf, Mahmoud
AU - Aranha, Francisco
AU - Annasetti, Claudio
AU - Apperley, Jane F.
AU - Baynes, Roy
AU - Bensinger, William I.
AU - Blaise, Didier
AU - Chaudhary, M. Ashraf
AU - Clarke, Mike
AU - Cornelissen, Jan J.
AU - Couban, Stephen
AU - Cutler, Corey
AU - Djulbegovic, Benjamin
AU - Gyger, Martin
AU - Gratwohl, Alois
AU - Heldal, Dag
AU - Hills, Robert K.
AU - Van Der Holt, Bronno
AU - Hozo, Iztok
AU - Kuentz, Mathieu
AU - Kumar, Ambuj
AU - Lipton, Jeff
AU - Matcham, James
AU - Mohty, Mohamad
AU - Morton, James
AU - Panzarella, Tony
AU - Powles, Ray
AU - Richards, Sue M.
AU - Sahovic, Entezam
AU - Schmitz, Norbert
AU - Simpson, David R.
AU - Sirohi, Bhawna
AU - Soares, Heloisa P.
AU - De Souza, Carmino A.
AU - Vigorito, Afonso C.
AU - Wheatley, Keith
PY - 2005
Y1 - 2005
N2 - Purpose: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. Patients and Methods: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95% CI, 0.25 to 0.38; P < .00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P < .00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P < .000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P < .000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage- (33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01). Conclusion: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.
AB - Purpose: Considerable uncertainty exists regarding relative effects of allogeneic peripheral blood stem cells transplantation (PBSCT) versus bone marrow transplantation (BMT) on outcomes of patients with hematologic malignancies. Patients and Methods: To provide the totality of research evidence related to the effects of PBSCT versus BMT, we conducted an individual-patient data meta-analysis using data from nine randomized trials enrolling 1,111 adult patients. Results: Compared with BMT, PBSCT led to faster neutrophil (odds ratio [OR] = 0.31; 95% CI, 0.25 to 0.38; P < .00001) and platelet engraftment (OR = 0.52; 95% CI, 0.44 to 0.61; P < .00001). PBSCT was associated with a significant increase in the development of grade 3-4 acute graft-versus-host disease (GVHD; OR = 1.39; 95% CI, 1.03 to 1.88) and extensive (47% v 31% at 3 years; OR = 1.89; 95% CI, 1.47 to 2.42; P < .000001) and overall chronic GVHD (68% v 52% at 3 years; OR = 1.92; 95% CI, 1.47 to 2.49; P < .000001), but not grade 2-4 acute GVHD (54% v 53%; P = .49). PBSCT was associated with a decrease in relapse (21% v 27% at 3 years; OR = 0.71; 95% CI, 0.54 to 0.93; P = .01) in both late-stage- (33% v 51% at 3 years; OR = 0.59; 95% CI, 0.38 to 0.93; P = .02) and early-stage-disease patients (16% v 20% at 3 years; OR = 0.69; 95% CI, 0.49 to 0.98; P = .04). Nonrelapse mortality was not different between groups. Overall and disease-free survival were only statistically significantly improved in patients with late-stage disease (overall survival: 46% v 31% at 3 years; OR = 0.64; 95% CI, 0.46 to 0.90; P = .01; disease-free survival: 41% v 27% at 3 years; OR = 0.63 95% CI, 0.45 to 0.87; P = .01). Conclusion: PBSCT is associated with a decreased relapse rate in hematologic malignancies and improvement in overall and disease-free survival in patients with late-stage disease. PBSCT is also associated with a significant risk of extensive chronic GVHD.
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U2 - 10.1200/JCO.2005.09.020
DO - 10.1200/JCO.2005.09.020
M3 - Article
C2 - 16051954
AN - SCOPUS:24644503670
SN - 0732-183X
VL - 23
SP - 5074
EP - 5087
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 22
ER -