5 Year Results of BMT CTN 0201: Unrelated Donor Bone Marrow Is Associated with Better Psychological Well-Being and Less Burdensome Chronic Gvhd Symptoms Than Peripheral Blood

BMT CTN 0201 was a randomized study of unrelated donor bone marrow (BM) vs. peripheral blood (PB) (N=551) in hematopoietic cell transplantation (HCT) for hematologic malignancies. The primary analysis after 2 years of follow up showed similar survival, disease-free survival and treatment-related mortality between the graft types. There was a higher rate of graft failure with bone marrow (9% vs. 3%, p=0.002) and a higher rate of chronic GVHD with peripheral blood (53% vs. 41%, p=0.01). (Anasetti et al, NEJM 2012) Patient reported outcomes (PROs) were collected from patients > 16 years old at enrollment and 0.5, 1, 2 and 5 years after transplantation with the Functional Assessment of Cancer Therapies – Bone Marrow Transplant (FACT-BMT), Mental Health Inventory (MHI), and Lee chronic graft-versus-host disease (cGVHD) symptom scale. At 5 years, 102 BM and 93 PB participants were alive and eligible for the quality of life (QOL) study. Clinically meaningful differences (changes in scores that are noticeable to patients) were considered 0.5 x standard deviation of the total population based on the distribution method. Results: Data as of 5/25/15 were analyzed. 70% completed the pre-randomization assessment, and 74-78% of adult survivors completed the 5 year assessment. Age < 30 at transplant and high risk disease were associated with missing 5 year data, but not graft source. Response rates at 0.5, 1 and 2 years were 28-43% of survivors. There are no differences in any of the primary QOL scores in the first two years after HCT using univariate comparisons, although missing data severely limit conclusions during this period.  At 5 years, the FACT-Trial Outcome Index (TOI), the MHI Psychological Well-Being, and the cGVHD symptom scale scores are all significantly better for BM patients, although only the latter two are still significant after adjustment for multiple testing (p<0.0125 because of 4 primary QOL variables). Results were similar when tested in multivariate models adjusting for baseline patient-reported scores and also imputing missing values based on patient characteristics (Table). Of the 7 chronic GVHD subscales, symptoms in the eye, lung, and energy were significantly better with BM (p<0.01). A diagnosis of cGVHD was highly associated with patient-reported cGVHD symptoms but not with QOL or psychological status. Inclusion of extensive cGVHD in the multivariate models did not change the significance of PRO differences suggesting that differences in cGVHD incidence do not explain the PRO findings. With a median follow up of 73 months for survivors, no difference in survival between PB and BM is observed (p=0.84, Figure). Conclusion: At 5 years after transplant, recipients of unrelated donor BM have better psychological well-being and less burdensome chronic GVHD symptoms than recipients of PB. Survival rates are similar.

Table. Comparisons of primary QOL variables at 5 years, adjusted for QOL values at baseline and missing data using inverse probability weighting using significant clinical characteristics.

QOL scale	Bone marrow (n=102)	Peripheral blood (n=93)	P value	Clinically significant difference*	Difference between BM and PB (95% CI)
FACT-BMT TOI, mean +/- SE (higher scores better)	76.7 +/- 1.6 (n=79)	70.5 +/- 1.9 (n=69)	0.014	8.5	6.2 (1.3-11.1)
MHI – Psychological well-being, mean +/- SE (higher scores better)	78.9 +/- 1.7 (n=80)	72.2 +/- 1.9 (n=72)	0.011	8.4	6.7 (1.6-11.8)
MHI-Psychological Distress, mean +/- SE (lower scores better)	16.0 +/- 1.3 (n=80)	19.0 +/- 1.5 (n=71)	0.128	6.5	-3.0 (-6.8,0.9)
Chronic GVHD symptoms, mean +/- SE (lower scores better)	13.1 +/- 1.5 (n=80)	19.3 +/- 1.6 (n=72)	0.004	7.1	-6.3 (-10.5, -2.0)
SE, standard error *0.5 x STD

Figure