Author/Authors :
N. Schmitz، نويسنده , , P. Dreger، نويسنده , , D. C. Linch، نويسنده , , A. H. Goldstone، نويسنده , , M. A. Boogaerts، نويسنده , , H. M. S. Demuynck، نويسنده , , A. Ferrant، نويسنده , , A. Zander، نويسنده , , H. Link، نويسنده , , A. Barge، نويسنده , , K. Borkett، نويسنده ,
Abstract :
Background A randomised trial comparing filgrastim-mobilised peripheral blood progenitor cell (PBPC) transplants with autologous bone marrow transplantation (ABMT) for haematopoietic stem cell support has not been done. We compared the effects of filgrastim-mobilised PBPC or autologous bone marrow reinfused to lymphoma patients after high-dose chemotherapy in a prospective randomised multicentre trial.
Methods The trial was done at six centres in three European countries. After high-dose chemotherapy (carmustine, etoposide, cytarabine, and melphalan [BEAM protocol]) 58 patients with advanced Hodgkinʹs disease or high-grade non-Hodgkin lymphoma received either filgrastim-mobilised PBPC (n=27) or bone marrow (n=31) for haemopoietic reconstitution.
Findings The median number of days with platelet transfusions after grafting was 6 in the PBPC transplantation group and 10 in the ABMT group (estimate of treatment difference 5 days, 95% Cl 3-7 days). Time to platelet recovery above 20×109/L was 16 days in the PBPC transplantation group and 23 days in the ABMT group (p=0·02). Time to neutrophil recovery above 0·5×109/L was also reduced in the PBPC transplantation group (11 vs 14 days, P=0·005). Patients randomised to PBPC transplantation needed fewer red blood cell transfusions (two vs three, P=0·002) and spent less time in hospital (17 vs 23 days, P=0·002). Early post-transplant morbidity and mortality as well as overall survival (median follow-up 311 days) were similar in both groups. There was no notable toxicity ascribed to filgrastim administration or the leucapheresis procedures.
Interpretation In patients with lymphoma treated with high-dose chemotherapy, reinfusing filgrastim-mobilised PBPC instead of autologous bone marrow significantly reduced the number of platelet transfusions, the time to platelet and neutrophil recovery, and led to earlier discharge from hospital.
