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Background/Aim. Peripheral blood (PB) is used more frequently as a source of  stem cells (SCs) for allogeneic transplantation. However, the influence of  cell source on the clinical outcome of SC transplantation is not yet well  established. The aim of this study was to compare the results of PBSC  transplantation (PBSCT) with bone marrow transplantation (BMT) on the basis  of engraftment, frequency and severity of immediate (mucositis, acute Graft  versus Host Disease - aGvHD) and delayed (chronic GvHD - cGvHD)  complications, as well as transplant-related mortality (TRM), transfusion  needs, relapses and overall survival (OS). Methods. We analyzed 158 patients,  women/men ratio 64/94 median age 29 (range 9-57), who underwent allogeneic SC  transplantation between 1989 and 2009. All included patients had diseases as  follows: acute myeloid leukemia (AML) - 39, acute lymphoblastic leukemia  (ALL) - 47, chronic myeloid leukemia (CML) - 32, myelodysplastic syndrome  (MDS) - 10, Hodgkin’s lymphoma (HL) - 2, multiple myeloma (MM) - 3,  granulocytic sarcoma (GrSa) - 3, severe aplastic anemia (sAA) - 22. The  patients underwent transplantations were divided into two groups: BMT group  (74 patients) and PBSCT group (84 patients). Each recipient had HLA identical  sibling donor. SCs from bone marrow were collected by multiple aspirations of  iliac bone and from PB by one “Large Volume Leukapheresis” (after recombinant  human granulocyte colony stimulating factor, rHuG-CSF) application (5-12  μg/kgbm, 5 days). Conditioning regimens were applied according to primary  disease, GvHD prophylaxis consisted of combination of a cyclosporine A and  methotrexate. Results. Engraftment, according to the count of  polymorphonuclear and platelets, were significantly (p < 0.001) faster in the  PBSCT vs BMT group. The needs for transfusion support were significantly (p <  0.01) higher in the BMT group. Those patients had more frequently  oropharingeal mucositis grade 3/4 (33.3% vs 10.0%, p < 0.05). There were no  significant differences in the incidence of aGvHD and cGvHD between the two  groups. The patients who underwent PBSCT had more frequently extensive cGvHD  in comparison with the BMT group (29.1% vs 11.29%, p < 0.05). SC source (SCS)  had no significant influence on the TRM (21.62% vs 23.8%, p = 0.64) and the  incidence of relapses (21.6% vs 29.7%, p = 0.32). Finally, the patients  treated by BMT had a significantly better OS (logrank 2.33, p < 0.05).  Conclusion. SCs harvesting from PB resulted in improved cell yield, faster  engraftment, as well as in a decrease of immediate transplantation related  complications with a reduced treatment cost. Allogeneic PBSCT were associated  with more frequent extensive cGvHD, while the influence of SCS in TRM and  relapses was not observed. Finally, the longterm OS was better in the  patients treated by BMT. To verify impact of SC source on transplantation  (PBSCT vs BMT) overall efficacy, more larger randomized clinical studies are  needed

Impact of stem cell source on allogeneic stem cell transplantation outcome in hematological malignancies