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

• 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
• Journal Title: JAMA Oncology
• Volume: Volume 2, Number 12
• Publisher: American Medical Association | 2016-12-01, Pages 1583-1589
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1001/jamaoncol.2016.2520
• Subjects: Health Sciences, Public Health; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; QUALITY-OF-LIFE; HEMATOPOIETIC-CELL TRANSPLANTATION; VERSUS-HOST-DISEASE; PSYCHOLOGICAL DISTRESS; FUNCTIONAL STATUS; HEALTH; CANCER; SCALE

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.