PROs best with bone marrow unrelated donor transplantation
medwireNews: For patients undergoing unrelated donor haematopoietic cell transplantation, bone marrow should be used as the graft source instead of peripheral blood, say researchers who found that bone marrow recipients fared better with respect to certain self-reported measures.
These results come from a follow-up of a randomised clinical trial that showed comparable survival and relapse rates for the two graft sources in patients with acute or chronic leukaemia, myelodysplasia or myelofibrosis.
The researchers note, however, that the primary findings did not lead to any change in the proportion of bone marrow grafts being used, and wonder whether the additional information provided by this follow-up analysis will be deemed sufficient to bring about a practice change.
Of 551 trial participants included in the patient-reported outcomes (PROs) analysis, 102 who received a bone marrow graft and 93 peripheral blood recipients were evaluated after 5 years.
After adjusting for baseline scores and missing data, bone marrow recipients performed significantly better on the Mental Health Inventory (MHI) Psychological Well-Being scale than those given peripheral blood grafts, with average scores of 78.9 and 72.2, respectively.
And participants given donor bone marrow also reported significantly less burdensome chronic graft-versus-host disease (GVHD) symptoms as assessed by the Lee scale, with mean scores of 13.1 versus 19.3 for the peripheral blood group.
Furthermore, after 5 years, bone marrow recipients were a significant 50% more likely to be working full- or part-time after taking into account baseline work status.
And there were no PROs for which peripheral blood was superior, report Stephanie Lee, from the Fred Hutchinson Cancer Research Center in Seattle, Washington, USA, and co-authors in JAMA Oncology.
Similar to the primary analysis, they found that the donor bone marrow and peripheral blood groups were comparable with respect to survival, relapse and treatment-related mortality after a median follow-up of 73 months.
Lee et al admit that they are only confident about their results at enrolment and at 5 years, as the response rates at intermediate timepoints (6 months, 1 and 2 years post-transplant) were low, “leaving a large period without accurate patient-reported experiences”.
Nonetheless, they believe that “[b]one marrow should be the standard of care for these types of transplant procedures.”
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