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Peripheral blood or bone marrow cells in reduced-intensity or myeloablative conditioning allogeneic HLA identical sibling donor transplantation for multiple myeloma

From the Karolinska University Hospital, Huddinge, Stockholm, Sweden (GG, BB); Leiden University Medical Centre, Leiden, The Netherlands (SI); Hospital San Orsola, Bologna, Italy (GB); University of Milan, Milan, Italy (PC); Addenbrookes Hospital, Cambridge, UK (CC); University of Heidelberg, Heidelberg, Germany (UH, SOS); Royal Marsden Hospital, Sutton, UK (GM); University Medical Centre Utrecht, Utrecht, The Netherlands (LFV) University Hospital Eppendorf , Hamburg, Germany (GMNK); Helsinki University Central Hospital, Helsinki, Finland (LV); University Medical Center St. Radboud, Nijmegen, The Netherlands (AS, TdW); University of Leipzig, Leipzig, Germany (DN); European Group for Blood and Marrow Transplantation (MSotE)

Correspondence: Gösta Gahrton, Department of Medicine, Karolinska institutet, Karolinska University Hospital, Huddinge, SE 14186 Stockholm, Sweden. E-mail: gosta.gahrton{at}ki.se

Background and Objectives: Peripheral blood stem cells (PBSC) following reduced intensity conditioning (RIC) are being increasingly used for allogeneic transplantation in multiple myeloma. The purpose of this study was to compare outcome of patients transplanted with either PBSC or bone marrow (BM) following RIC or myeloablative conditioning (MAC).

Design and Methods: Data from 1,667 patients who had received an allogeneic identical sibling donor transplant for multiple myeloma from 1994 to 2003 were analyzed. Comparisons were made between results of PBSC and BM transplants after conditioning with RIC or MAC.

Results: The engraftment rate was faster with PBSC than with BM (median: 14 and 18 days for neutrophils and 15 and 25 days for platelets respectively) irrespectively of whether RIC or MAC was used. The incidence of acute graft-versus-host disease (GVHD) did not differ significantly between the groups while chronic GVHD was more prevalent in PBSC recipients irrespectively of whether they had RIC or MAC. Non-relapse mortality did not differ between PBSC and BM recipients, but was significantly higher in those treated with MAC than in those given RIC irrespectively of the cell source. The relapse/progression rate did not differ between PBSC and BM recipients, but was significantly higher in those given RIC, irrespectively of the cell source. There was no significant difference in overall or progression-free survival between patients given PBSC or BM transplants.

Interpretation and Conclusions: Although transplantation of PBSC is associated with faster engraftment and more frequent chronic GVHD, overall survival, non-relapse mortality, relapse/progression and progression-free survival are similar to those following BM transplants. However both PBSC and BM transplants are associated with lower non-relapse mortality, lower response rate and higher relapse/progression if RIC is used instead of MAC.

Key words: peripheral blood stem cell trasplantation, bone marrow trasplantation, reduced intensity conditioning, myeloablative conditioning, multiple myeloma.