• Stephen Couban, Mahmoud Aljurf, Sylvie Lachance, Irwin Walker, Cynthia Toze, Morel Rubinger, Jeffrey H Lipton, Stephanie J Lee, Jeff Szer, Richard Doocey, Ian D Lewis, Lothar Huebsch, Kang Howson-Jan, Michel Lalancette, Fahad Almohareb, Nadeem Chaudhri, Sabine Ivison, Raewyn Broady, Megan Levings, Diane Fairclough, Gerald Devins, David Szwajcer, Ronan Foley, Clayton Smith, Tony Panzarella, Holly Kerr, Amina Kariminia, and Kirk R Schultz.
• Department of Medicine, Capital District Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: stephen.couban@nshealth.ca.
• Biol. Blood Marrow Transplant. 2016 Aug 1; 22 (8): 1410-1415.

AbstractIn adult hematopoietic cell transplantation (HCT), filgrastim-mobilized peripheral blood (G-PB) has largely replaced unstimulated marrow for allografting. Although the use of G-PB results in faster hematopoietic recovery, it is also associated with more chronic graft-versus-host disease (cGVHD). A potential alternative allograft is filgrastim-stimulated marrow (G-BM), which we hypothesized may be associated with prompt hematopoietic recovery but with less cGVHD. We conducted a phase 3, open-label, multicenter randomized trial of 230 adults with hematologic malignancies receiving allografts from siblings after myeloablative conditioning to compare G-PB with G-BM. The primary endpoint was time to treatment failure, defined as a composite of extensive cGVHD, relapse/disease progression, and death. With a median follow-up of 36 months (range, 9.6 to 48), comparing G-BM with G-PB, there was no difference between the 2 arms with respect to the primary outcome of this study (hazard ratio [HR], .91; 95% confidence interval [CI], .68 to 1.22; P = .52). However, the cumulative incidence of overall cGVHD was lower with G-BM (HR, .66; 95% CI, .46 to .95; P = .007) and there was no difference in the risk of relapse or progression (P = .35). The median times to neutrophil recovery (P = .0004) and platelet recovery (P = .012) were 3 days shorter for recipients allocated to G-PB compared with those allocated to G-BM, but there were no differences in secondary engraftment-related outcomes, such as time to first hospital discharge (P = .17). In addition, there were no graft failures in either arm. This trial demonstrates that, compared with G-PB, the use of G-BM allografts leads to a significantly lower rate of overall cGVHD without a loss of the graft-versus-tumor effect and comparable overall survival. Our findings suggest that further study of this type of allograft is warranted.Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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