Correspondence
Hematopoietic Reconstitution by Transplantation of Stem Cells from Bone Marrow or Blood
N Engl J Med 2001; 344:1641-1642May 24, 2001
- Article
To the Editor:
We have reported a significantly lower rate of relapse of hematologic cancers after allogeneic blood-cell transplantation than after bone marrow transplantation in a double-blind, randomized study.1 We believe that the reduced rate was due to faster lymphocyte recovery after the transplantation of blood-cell allografts.2
On the basis of these observations, we started using blood cells exclusively for allografts from HLA-matched siblings a few years ago. The data reported by Bensinger et al. (Jan. 18 issue)3 reinforce our position and suggest that a change in general clinical practice is warranted.
3 ReferencesSeema Singhal, M.D.
Northwestern University Medical School, Chicago, IL 60611Ray Powles, M.D.
Royal Marsden Hospital, Sutton SM2 5PT, United KingdomJayesh Mehta, M.D.
Northwestern University Medical School, Chicago, IL 606111
Powles R ,Mehta J ,Kulkarni S , et al. Allogeneic blood and bone-marrow stem-cell transplantation in haematological malignant diseases: a randomised trial. Lancet 2000;355:1231-1237
CrossRef | Web of Science | Medline2
Powles R ,Singhal S ,Treleaven J ,Kulkarni S ,Horton C ,Mehta J . Identification of patients who may benefit from prophylactic immunotherapy after bone marrow transplantation for acute myeloid leukemia on the basis of lymphocyte recovery early after transplantation. Blood 1998;91:3481-3486
Web of Science | Medline3
Bensinger WI ,Martin PJ ,Storer B , et al. Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers. N Engl J Med 2001;344:175-181
Full Text | Web of Science | Medline
To the Editor:
On the basis of their study of the transplantation of allogeneic bone marrow as compared with peripheral-blood stem cells, Bensinger et al. conclude that the risk of graft-versus-host disease (GVHD) is not increased by the use of peripheral-blood stem cells. However, the 95 percent confidence intervals for the hazard ratios for acute and chronic GVHD were reported to be 0.81 to 1.81 and 0.71 to 1.90, respectively, for the peripheral-blood–cell group as compared with the bone marrow group. Therefore, the data do not exclude the possibility that the use of allogeneic peripheral-blood stem cells nearly doubles the risk of both acute and chronic GVHD.
Thomas R. Klumpp, M.D.
Fox Chase–Temple University Bone Marrow Transplant Program, Philadelphia, PA 19111To the Editor:
Bensinger et al. do not distinguish between limited and extensive chronic GVHD. This distinction is important because extensive, chronic GVHD has an adverse clinical course.1 The cumulative incidence of chronic GVHD needs to be reported separately for limited and extensive disease in order for readers to have a better understanding of the data.
1 ReferencesHakan Goker, M.D.
Hacettepe University Hospital, 06100 Ankara, TurkeyAuthor/Editor Response
The authors reply:
To the Editor: Our comparison of allogeneic peripheral-blood stem cells with marrow demonstrated improved disease-free survival and suggested a benefit in terms of overall survival in the group that received peripheral-blood stem cells. A subgroup analysis, however, indicated that this benefit was greater in the group of patients with more advanced hematologic cancers than in the group with less advanced cancers, because there were fewer transplant-related deaths and relapses in the former group. Our study was not prospectively designed to detect these differences in survival, so caution must be used in interpreting these results.
Since there was a trend toward a higher incidence of GVHD in the group that received peripheral-blood stem cells, further studies need to be performed to determine whether the benefits of peripheral-blood stem cells outweigh the potentially greater risk of GVHD. Thus, we do not fully agree with Singhal et al. that peripheral blood should be universally used as the preferred source of stem cells in all patients undergoing allogeneic transplantation for hematologic cancers. The trial suggested a trend toward a higher incidence of GVHD in the peripheral-blood–cell group, but with wide 95 percent confidence intervals; we agree with Klumpp that it is possible and perhaps even likely that the use of peripheral-blood stem cells is associated with some increase in the risk of GVHD. We reported only on patients in whom extensive, chronic GVHD developed, since limited, chronic GVHD does not require treatment and is not associated with an adverse clinical outcome.
William I. Bensinger, M.D.
Barry Storer, Ph.D.
Frederick R. Appelbaum, M.D.
Fred Hutchinson Cancer Research Center, Seattle, WA 98109- Citing Articles (3)
Citing Articles
1
Jinxu Wang, Xin Tong, Peibo Li, Hui Cao, Weiwei Su. (2011) Immuno-enhancement effects of Shenqi Fuzheng Injection on cyclophosphamide-induced immunosuppression in Balb/c mice. Journal of Ethnopharmacology
CrossRef2
Jung Hwa Choi, Hyewon Yoon, Chang-Ki Min, Eun Young Choi. (2011) Effects of Pre-conditioning Dose on the Immune Kinetics and Cytokine Production in the Leukocytes Infiltrating GVHD Tissues after MHC-matched Transplantation. Immune Network 11:1, 68
CrossRef3
G Behre, S Theurich, T Weber, M Christopeit. (2009) Reply to ‘The correlation between cotransplantation of mesenchymal stem cells and higher recurrence rates in hematologic malignancy patients: outcome of a pilot clinical study’ by Ning et al.. Leukemia 23:1, 178-178
CrossRef
