Comparison of Patient-Reported Outcomes in 5-Year Survivors Who Received Bone Marrowvs Peripheral Blood Unrelated Donor Transplantation Long-term Follow-up of a Randomized Clinical Trial

• Type of Material: Article
• Authors: Stephanie J Lee, Fred Hutchinson Cancer Research Center; Brent Logan, Medical College of Wisconsin; Peter Westervelt, Washington University; Corey Cutler, Harvard Medical School; Ann Woolfrey, Fred Hutchinson Cancer Research Center; Shakila P. Khan, Mayo Clinic; Edmund K Waller, Emory University; Richard T. Maziarz, Oregon Health & Science University; Juan Wu, The Emmes Corporation; Bronwen Shaw, Medical College of Wisconsin; Dennis Confer, National Marrow Donor Program; Mary M. Horowitz, Medical College of Wisconsin; Claudio Anasetti, Moffitt Cancer Center
• Language: English
• Date: 2016-12-01
• Publisher: American Medical Association
• Publication Version: Final Published Version
• Copyright Statement: Copyright 2016 American Medical Association. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1001/jamaoncol.2016.2520
• Title of Journal or Parent Work: JAMA Oncology
• ISSN: 2374-2437
• Volume: 2
• Issue: 12
• Start Page: 1583
• End Page: 1589
• Grant/Funding Information: Support for this study was provided by grant #U10HL069294 from the National Heart, Lung, and Blood Institute and the National Cancer Institute to support the Blood and Marrow Transplant Clinical Trials Network that was responsible for design and conduct of the study, collection, management, and analysis of data, review and approval of the manuscript, and the Department of the Navy, Office of Naval Research, and the National Marrow Donor Program that collected and managed data.; Any views, opinions, findings, conclusions or recommendations expressed in this material are those of the author(s) and do not reflect the views or the official policy or position of the above mentioned parties.; Enrollment support was provided by DKMS Germany.
• Keywords: FUNCTIONAL STATUS; HEALTH; Science & Technology; HEMATOPOIETIC-CELL TRANSPLANTATION; PSYCHOLOGICAL DISTRESS; Life Sciences & Biomedicine; QUALITY-OF-LIFE; VERSUS-HOST-DISEASE; CANCER; SCALE; Oncology
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

IMPORTANCE Bone marrow or peripheral blood from unrelated donors may be used for hematopoietic cell transplantation. Information about the relative success of transplantation with these 2 graft sources would help physicians and patients choose between them. OBJECTIVE To compare patient-reported outcomes between patients randomized to receive 1 of 2 graft types for unrelated donor transplantation. DESIGN, SETTING, AND PARTICIPANTS This follow-up of a randomized clinical trial included English- or Spanish-speaking patients 16 years or older participating in a multicenter randomized clinical trial of unrelated donor bone marrow (BM) vs peripheral blood (PB) (N = 551) in hematopoietic cell transplantation for hematologic neoplasms. Patient-reported outcomes were collected from patients at enrollment and 0.5, 1, 2, and 5 years after transplantation. INTERVENTIONS Unrelated donor BM or PB hematopoietic cell transplantation. MAIN OUTCOMES AND MEASURES Functional Assessment of Cancer Therapy-Bone Marrow Transplant, Mental Health Inventory, occupational functioning, Lee Chronic Graft-vs-Host Disease Symptom Scale. RESULTS At 5 years after transplantation, 102 BMand 93 PB participants were alive and eligible for assessment (age-40 years or older: 104 [53.5%] male: 101 [51.8%] ). The mean (SE) Mental Health Inventory PsychologicalWell-Being scores (78.9 [1.7] vs 72.2 [1.9] P = .01 higher better) and Lee chronic graft-vs-host disease symptom scores (13.1 [1.5] vs 19.3 [1.6] P = .004 lower better) were significantly better for BMrecipients, adjusting for baseline scores and missing data. Recipients of BM were also more likely to be working full or part-time than recipients of PB (odds ratio, 1.5 95%CI, 1.2-2.0 P = .002), adjusting for work status before transplantation. With a median follow-up of 73 months (range, 30-121 months) for survivors, no differences in survival (40% vs 39% P = .84), relapse (32%vs 29% P = .47), or treatment-related mortality (29% vs 32% P = .44) between BM and PB were observed. CONCLUSIONS AND RELEVANCE Recipients of unrelated donor BM had better psychological well-being, less burdensome chronic GVHD symptoms, and were more likely to return to work than recipients of PB at 5 years after transplantation. Bone marrow should be the standard of care for these types of transplant procedures.