Peripheral blood progenitor cell transplants seen inferior to BMT in some patients

September 21, 2007

NEW YORK (Reuters Health) - Peripheral blood progenitor cell (PBPC) transplants for severe acquired aplastic anemia are associated with worse outcomes than bone marrow transplants (BMT) in young patients, according to a report in the August 15th issue of Blood.

"The higher rate of chronic graft-versus-host disease (GVHD) in patients who received peripheral blood grafts resulted in higher rates of mortality," Dr. Mary Eapen from the Medical College of Wisconsin, Milwaukee, told Reuters Health. "These are patients who otherwise (had they received bone marrow grafts) have an excellent outcome after HLA-matched sibling transplantation."

Dr. Eapen and associates investigated chronic GVHD and long-term overall survival rates in 134 PBPC recipients and 558 BM recipients of HLA-matched sibling donor transplants for severe aplastic anemia.

Median times to neutrophil and platelet recovery were faster after PBPC than BM transplantation, the team reports, but the probabilities of neutrophil recovery at day 28 and platelet recovery at day 100 were similar for the 2 groups.

Although the rates of acute GVHD did not differ significantly between the recipient groups, chronic GVHD rates were 2.82-fold higher after PBPC transplantation than after BM transplantation, in patients 20 years old and younger. Chronic GVHD rates in patients older than 20 years were similar between the groups, the investigators say.

In the younger patient group, overall mortality rates were twice as high after PBPC transplantation as after BM transplantation, whereas overall mortality rates in older patients were similar in the two recipient groups.

"The data reported favor bone marrow grafts for patients with severe aplastic anemia," Dr. Eapen said.

"Severe aplastic anemia is a rare disease, and some would argue it is not feasible to conduct a randomized trial because the trial would take several years to accrue and physicians will lose interest," Dr. Eapen commented. "Nevertheless, when exploring experimental therapies, always consider enrolling patients in clinical trials, and if none is readily available, refrain from offering these therapies," she advised.