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Use of bone marrow cells is associated with improved outcomes when compared to peripheral blood stem cell after haplo-identical transplants with post transplant cyclophosphamide, a study from of the CTIWP-EBMT

Bone Marrow Transplantation volume 61, pages 75–81 (2026)Cite this article

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Abstract

Few studies analyzed the impact of bone marrow (BM) or peripheral blood stem cells (PBSC) on outcomes after haploidentical transplantation using post-cyclophosphamide (Haplo-PTCY). We analyzed 8854 adults with malignant disorders, given a first Haplo-PTCY. BM cells was used in 2914 and PBSC in 5940 patients. Multivariate models were built adjusting for the statistical differences between the 2 groups. Median follow-up time for survivors in the BM and PBSC groups were 48 and 30 months, respectively. Neutrophil Engraftment was observed in 92.4% of BM and 93.7% of PBSC recipients (p = 0.01). In a multivariate analysis, use of PBSC compared to BM, was associated with higher incidence of acute (HR:1.53; p < 0.0001) and chronic GVHD (HR:1.34; p < 10-3), increased non-relapse mortality (HR:1.22; p = 0.002), similar risk of relapse (HR:1.02; p = 0.79), and decreased overall survival (OS)(HR:1.13; p = 0.008); progression-free survival (PFS)(HR:1.11; p = 0.024) and GVHD-Relapse free survival (GRFS) (HR:1.2; p < 10–3). In conclusion, use of BM cells is associated with better outcomes compared to PBSC after Haplo-PTCY. Future studies should investigate better GVHD prophylaxis in the PBSC-Haplo-PTCY setting and the association of measured T-cell or other subpopulations of lymphocyte content in the PBSC graft.

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Fig. 1: Main outcomes by graft source.

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Data availability

Data cannot be shared unless a specific request is sent to the EBMT. This was a multicenter retrospective study, conducted on behalf of the Cellular therapy and Immunobiology Working Party (CTIWP) of EBMT.

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Authors and Affiliations

  1. Serviço de hematologia e Terapia Celular, LIM31, Hospital das Clinicas da FMUSP, Sao Paulo, Brazil

    Vanderson Rocha

  2. Hospital Vila Nova Star, Rede D’Or, São Paulo, Brazil

    Vanderson Rocha

  3. Churchill Hospital, Hematology Department, Oxford University Hospitals, Oxford, UK

    Vanderson Rocha

  4. Hôpital Saint Louis APHP, Université de Paris Cité, Paris, France

    Myriam Labopin, Mohamad Mohty & Jacques Emmanuel Galimard

  5. IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Anna Maria Raiola

  6. Programme de Transplantation & Therapie Cellulaire, Marseille, France

    Raynier Devillier

  7. Istituto Clinico Humanitas, Milano, Italy

    Stefania Bramanti

  8. Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Fabio Ciceri & Annalisa Ruggeri

  9. Hospital Gregorio Marañón, Madrid, Spain

    Jose Luiz Diez-Martin

  10. Medicana International Hospital Istanbul, Istanbul, Turkey

    Yener Koc

  11. Klinikum Grosshadern, Munich, Germany

    Johanna Tischer

  12. Universita Cattolica S. Cuore, Rome, Italy

    Simona Sica

  13. Anadolu Medical Center Hospital, Kocaeli, Turkey

    Zafer Gülbas

  14. First State Pavlov Medical University of St. Petersburg, Petersburg, Russian Federation

    Aleksandr Kulagin

  15. Lucía López Corral, Hospital Clínico, Salamanca, Spain

    Lucía López Corral

  16. Clinical Hematology Department, Institut Català d’Oncologia-L’Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain

    Anna Sureda

Authors
  1. Vanderson Rocha
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  2. Myriam Labopin
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  17. Annalisa Ruggeri
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Consortia

from the Cellular Therapy & Immunobiology Working Party of the European Society for Blood and Marrow Transplantation

  • Annalisa Ruggeri

Contributions

VR and AR designed the study, VR and AR wrote the manuscript; ML performed the statistical analysis. JEG has reviewed the statistical analysis. AMR, RD, SB, FC, JLDM, YK, JT, SS, MM, ZG, AK, LLC, AS provided cases for the study. All authors edited and approved the manuscript. VR: honoraria of Takeda, Janssen, Amgen, Gilead Kite, Sanofi, Roche, Pierre Fabre. AS: Honoraria: Takeda, BMS/Celgene, MSD, Janssen, Amgen, Novartis, Gilead Kite, Sanofi, Roche, Alexion, Pierre Fabre, Jazz Pharmaceuticals, Verte. Consultancy: Takeda, BMS/Celgene, Novartis, Janssen, Gilead, Sanofi, GenMab, Abbvie, MSD, Incyte, Autolus, Regeneron, Pierre Fabre. Speaker’s Bureau: Takeda. Research Support: Takeda. Non-profit organizations: Presidency of the GETH-TC, Presidency of the EBMT. The remaining authors have no conflict of interest to disclose.

Corresponding author

Correspondence to Annalisa Ruggeri.

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The authors declare no competing interests.

Ethics approval and consent to participate

Data were collected according to EBMT rules. All patients or their legal guardians provided written informed consent for data collection and analysis in accordance with the Declaration of Helsinki, and with the centers’ ethical research guidelines. The scientific board of the CTIWP of the EBMT approved this study.

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Rocha, V., Labopin, M., Raiola, A.M. et al. Use of bone marrow cells is associated with improved outcomes when compared to peripheral blood stem cell after haplo-identical transplants with post transplant cyclophosphamide, a study from of the CTIWP-EBMT. Bone Marrow Transplant 61, 75–81 (2026). https://doi.org/10.1038/s41409-025-02735-7

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