A Randomized Study of Allogeneic Transplantation
In this study, 61 consecutive adult patients with leukemia, primary myelofibrosis, or myelodysplastic syndrome with an HLA-identical or 1 antigen-mismatched family donor were randomized to allogeneic transplantation with peripheral-blood progenitor cells (PBPC) or bone marrow stem cells. Progenitor cells were mobilized into the blood by giving the donors 10 µg/kg/d of the granulocyte colony-stimulating factor filgrastim subcutaneously for 5 to 7 days. Filgrastim was not given to patients after transplantation. The time to neutrophil counts greater than 0.5 3 10/L was 17 days (95% confidence interval [CI], 15.2-18.8 days) in the PBPC group compared with 23 days (95% CI, 20.3-25.7 days) in the BMT group (P = .0005). The time to platelet counts greater than 20 3 10/L was 13 days (95% CI, 11.7-14.3 days) in the PBPC group and 21 days (95% CI, 18.7-23.3 days) in the BMT group (P = .0005). Acute graft-versus-host disease (GVHD) of grades II to IV developed in 6 patients transplanted with PBPC and 3 patients transplanted with bone marrow. The numbers of patients with chronic GVHD were 15 and 8, respectively. No significant differences were seen in transplant-related mortality or leukemia-free survival. Transplantation with PBPC appears to be preferable for the recipi- ent because of faster neutrophil and platelet recovery. However, a final conclusion cannot be drawn before long-term results on chronic GVHD and relapse incidence in longer, randomized trials become available.