1. ¹Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
2. ²Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
3. ³Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

Correspondence: Dr JT Horan, Department of Pediatrics, Box 777, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, USA

Received 25 November 2002; Accepted 9 February 2003.

Abstract

The impact of peripheral blood stem cell transplantation (PBSCT) on survival relative to bone marrow transplantation (BMT) remains poorly defined. Several randomized controlled trials (RCTs) comparing HLA-matched related PBSC- and BMT for patients with hematologic malignancies have been published, yielding differing results. We conducted a meta-analysis of published RCTs to more precisely estimate the effect of PBSCT on survival. Seven trials that assessed survival were identified and included in our analysis. Using a fixed effects model, and combining the results of all seven trials, the summary odds ratio for mortality after PBSCT was 0.81 (95% CI, 0.62–1.05) when compared to BMT. Subgroup analysis revealed no association between the median PBSCT 34+ cell dose and relative risk for morality after PBSCT. However, there was an association between the proportion of patients enrolled with advanced-stage disease and the summary odds ratio for mortality. The pooled estimate was 0.64 for studies where patients with intermediate/advanced disease comprised at least 25% of enrollment, and was 1.07 for the studies enrolling a smaller proportion. This finding substantiates results from previously published studies that have demonstrated a survival advantage with PBSCT limited to patients with advanced disease.