Impact of stem cell source on allogeneic stem cell transplantation outcome in hematological malignancies
Authors: Stamatovic Dragana , Balint Bela , Tukic Ljiljana , Elez Marija , Tarabar Olivera , Todorovic Milena , Ostojic Gordana , Tatomirovic Zeljka , Ljubenov Marika , Marjanovic Slobodan , Malesevic Milomir 
Published: December 2011

Background/Aim. Peripheral blood (PB) is used more frequently as a source of
stem cells (SCs) for allogeneic transplantation. However, the influence of
cell source on the clinical outcome of SC transplantation is not yet well
established. The aim of this study was to compare the results of PBSC
transplantation (PBSCT) with bone marrow transplantation (BMT) on the basis
of engraftment, frequency and severity of immediate (mucositis, acute Graft
versus Host Disease - aGvHD) and delayed (chronic GvHD - cGvHD)
complications, as well as transplant-related mortality (TRM), transfusion
needs, relapses and overall survival (OS). Methods. We analyzed 158 patients,
women/men ratio 64/94 median age 29 (range 9-57), who underwent allogeneic SC
transplantation between 1989 and 2009. All included patients had diseases as
follows: acute myeloid leukemia (AML) - 39, acute lymphoblastic leukemia
(ALL) - 47, chronic myeloid leukemia (CML) - 32, myelodysplastic syndrome
(MDS) - 10, Hodgkin?s lymphoma (HL) - 2, multiple myeloma (MM) - 3,
granulocytic sarcoma (GrSa) - 3, severe aplastic anemia (sAA) - 22. The
patients underwent transplantations were divided into two groups: BMT group
(74 patients) and PBSCT group (84 patients). Each recipient had HLA identical
sibling donor. SCs from bone marrow were collected by multiple aspirations of
iliac bone and from PB by one ?Large Volume Leukapheresis? (after recombinant
human granulocyte colony stimulating factor, rHuG-CSF) application (5-12
?g/kgbm, 5 days). Conditioning regimens were applied according to primary
disease, GvHD prophylaxis consisted of combination of a cyclosporine A and
methotrexate. Results. Engraftment, according to the count of
polymorphonuclear and platelets, were significantly (p < 0.001) faster in the
PBSCT vs BMT group. The needs for transfusion support were significantly (p <
0.01) higher in the BMT group. Those patients had more frequently
oropharingeal mucositis grade 3/4 (33.3% vs 10.0%, p < 0.05). There were no
significant differences in the incidence of aGvHD and cGvHD between the two
groups. The patients who underwent PBSCT had more frequently extensive cGvHD
in comparison with the BMT group (29.1% vs 11.29%, p < 0.05). SC source (SCS)
had no significant influence on the TRM (21.62% vs 23.8%, p = 0.64) and the
incidence of relapses (21.6% vs 29.7%, p = 0.32). Finally, the patients
treated by BMT had a significantly better OS (logrank 2.33, p < 0.05).
Conclusion. SCs harvesting from PB resulted in improved cell yield, faster
engraftment, as well as in a decrease of immediate transplantation related
complications with a reduced treatment cost. Allogeneic PBSCT were associated
with more frequent extensive cGvHD, while the influence of SCS in TRM and
relapses was not observed. Finally, the longterm OS was better in the
patients treated by BMT. To verify impact of SC source on transplantation
(PBSCT vs BMT) overall efficacy, more larger randomized clinical studies are
needed.