Improved outcomes using G-CSF-mobilized blood and bone marrow grafts as the source of stem cells compared with G-PB after HLA-identical sibling transplantation in patients with acute leukemia

This retrospective study compared the transplantation outcomes of 98 consecutive patients with acute leukemia. Allogeneic hematopoietic stem cell transplantation was performed using G-CSF-mobilized bone marrow and blood (G-BM&PB) or G-CSF-mobilized peripheral blood (G-PB) from HLA-identical sibling donors. The G-BM&PB and G-PB groups displayed significantly different neutrophil recovery rates (medians of 15 vs. 14d, respectively; p=0.009) but similar platelet recovery rates. The cumulative incidences of grades II-IV acute graft-versus-host disease (aGVHD) in the G-BM&PB and G-PB cohorts were similar (16.2 +/- 4.7% vs. 21.8 +/- 7.4%, respectively; p=0.676), but the incidences of grades III-IV aGVHD were significantly different (5.5 +/- 3.1% vs. 18.9 +/- 7.1%, respectively; p=0.042). The G-BM&PB and G-PB cohorts displayed similar cumulative incidences of chronic GVHD (cGVHD, 49.1 +/- 5.7% vs. 42.7 +/- 6.8%, respectively; p=0.465), one-yr cumulative incidences of treatment-related mortality (16.5 +/- 3.5% vs. 24.4 +/- 4.1%, respectively; p=0.220), and five-yr cumulative incidences of relapse (13.9 +/- 4.8% vs. 26.8 +/- 7.2%, respectively; p=0.113). The five-yr probability of leukemia-free survival (LFS) was significantly higher in the G-BM&PB group than in the G-PB group (77.8 +/- 5.2% vs. 57.6 +/- 8.6%, respectively; p=0.023). Multivariate analysis identified G-PB as an independent risk factor for grades III-IV aGVHD and LFS. Our results suggest that HLA-identical transplantation with G-BM&PB results in superior clinical outcomes compared with G-PB for patients with acute leukemia.