Survival after HLA-identical allogeneic peripheral blood stem cell and bone marrow transplantation for hematologic malignancies: meta-analysis of randomized controlled trials

Bone Marrow Transplant. 2003 Aug;32(3):293-8. doi: 10.1038/sj.bmt.1704112.

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.

Publication types

  • Comparative Study
  • Meta-Analysis

MeSH terms

  • Adult
  • Antigens, CD34
  • Bone Marrow Transplantation / mortality*
  • Cell Count
  • Disease Progression
  • Female
  • HLA Antigens
  • Hematologic Neoplasms / mortality
  • Hematologic Neoplasms / therapy*
  • Histocompatibility*
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Peripheral Blood Stem Cell Transplantation / mortality*
  • Randomized Controlled Trials as Topic / statistics & numerical data
  • Risk Factors
  • Survival Analysis
  • Transplantation, Homologous

Substances

  • Antigens, CD34
  • HLA Antigens