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Allogeneic PBPC transplantation: an effect on incidence and distribution of chronic graft-versus-host disease without long-term survival benefit?

Bone Marrow Transplantation volume 25, pages 119–120 (2000)Cite this article

Compared with allogeneic bone marrow transplantation (BMT), allogeneic peripheral blood progenitor transplantation (PBPCT) is associated with a shortened time to engraftment and a similar incidence of acute graft-versus-host disease (GVHD).1 However, at present it is unclear whether there is an excess of chronic GVHD123 or perhaps most importantly, any survival advantage. A recent IBMTR analysis has shown that patients surviving beyond 2 years after BMT have a high probability of long-term survival (ie 89%).4 In order to evaluate our experience at St Vincent's Hospital, Sydney, we have compared long-term follow-up data (ie longer than 2 years) from the first 16 patients to undergo allogeneic PBPCT with rigorously matched controls undergoing allogeneic BMT with an otherwise identical protocol.

Patients were aged between 16 and 57 years and were receiving their first allogeneic transplant following conditioning with a variety of preparative regimens. HLA-A, -B, -DR-identical, mixed lymphocyte culture non-reactive sibling donors were mobilised with filgrastim 10 μg/kg/day. Leukapheresis was commenced on day 5 and continued until the target minimum of 4.0 × 106 CD34+ cells per kg recipient weight were collected. GVHD prophylaxis was intravenous cyclosporin A 3 mg/kg/day until bowel function was normal, when oral cyclosporin 12.5 mg/kg/day in two divided doses was substituted, and methotrexate which was given according to our departmental protocol5 at a dose of 7.5 mg/m2 on days 1, 3, 6 and 11 post transplant. Day 11 methotrexate was omitted in patients who had severe mucositis. Supportive care was with a standardised protocol which included prophylaxis with ganciclovir, fluconazole, cotrimoxazole and heparin.

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Acknowledgements

We thank the Arrow Foundation for their support.

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  1. Department of Haematology, St Vincent's Hospital, Sydney, NSW 2010, Australia

    JA Snowden, I Nivison-Smith, K Atkinson, K Fay, A Concannon, A Dodds, S Milliken & J Biggs

  2. Dept of Haematology, Leicester Royal Infirmary, Leicester, LE1 5WW, UK

    JA Snowden

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  1. JA Snowden
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  2. I Nivison-Smith
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  7. S Milliken
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  8. J Biggs
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Snowden, J., Nivison-Smith, I., Atkinson, K. et al. Allogeneic PBPC transplantation: an effect on incidence and distribution of chronic graft-versus-host disease without long-term survival benefit?. Bone Marrow Transplant 25, 119–120 (2000). https://doi.org/10.1038/sj.bmt.1702090

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