Comparison of Outcomes after Transplantation of G-CSF-Stimulated Bone Marrow Grafts versus Bone Marrow or Peripheral Blood Grafts from HLA-Matched Sibling Donors for Patients with Severe Aplastic Anemia

We compared outcomes of patients with severe aplastic anemia (SAA) who received granulocyte-colony stimulating factor (G-CSF)-stimulated bone marrow (G-BM) (n=78), unstimulated bone marrow (BM) (n=547), or peripheral blood progenitor cells (PBPC) (n=134) from an HLA-matched sibling. Transplantations occurred in 1997 to 2003. Rates of neutrophil and platelet recovery were not different among the 3 treatment groups. Grade 2-4 acute graft-versus-host disease (aGVHD) (relative risk [RR]=0.82, P=.539), grade 3-4 aGVHD (RR=0.74, P=.535), and chronic GVHD (cGVHD) (RR=1.56, P=.229) were similar after G-BM and BM transplants. Grade 2-4 aGVHD (RR=2.37, P=.012) but not grade 3-4 aGVHD (RR=1.66, P=.323) and cGVHD (RR=5.09, P<.001) were higher after PBPC transplants compared to G-BM. Grade 2-4 (RR=2.90, P<.001), grade 3-4 (RR=2.24, P=.009) aGVHD and cGVHD (RR=3.26, P<.001) were higher after PBPC transplants compared to BM. Mortality risks were lower after transplantation of BM compared to G-BM (RR=0.63, P=.05). These data suggest no advantage to using G-BM and the observed higher rates of aGVHD and cGVHD in PBPC recipients warrants cautious use of this graft source for SAA. Taken together, BM is the preferred graft for HLA-matched sibling transplants for SAA. Biol Blood Marrow Transplant 17: 1018-1024 (2011) (C) 2011 American Society for Blood and Marrow Transplantation