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Biol Blood Marrow Transplant. 2016 Mar;22(3):449-55. doi: 10.1016/j.bbmt.2015.10.018. Epub 2015 Nov 2.

Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation.

Author information

  • 1Division of Hematology, Oncology and Transplant, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: arora005@umn.edu.
  • 2Division of Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
  • 3Division of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, Tennessee.
  • 4Blood and Marrow Transplantation Program, Moffitt Cancer Center, Tampa, Florida.
  • 5Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
  • 6Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
  • 7BMT Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
  • 8Division of Hematology and Oncology, University of North Carolina Hospitals, Chapel Hill, North Carolina.
  • 9Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
  • 10Division of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
  • 11Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California.
  • 12Division of Hematology and Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
  • 13Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.

Abstract

Several distinct graft-versus-host disease (GVHD)-related syndromes have been defined by the National Institutes of Health Consensus Conference. We enrolled a prospective cohort of 911 hematopoietic cell transplantation (HCT) recipients at 13 centers between March 2011 and May 2014 to evaluate 4 GVHD syndromes: late acute GVHD (aGVHD), chronic GVHD (cGVHD), bronchiolitis obliterans syndrome, and cutaneous sclerosis. The median age at HCT was 53.7 years. The majority of patients received a peripheral blood stem cell transplant (81%) following nonmyeloablative or reduced-intensity conditioning (55%). Pediatric age group and use of bone marrow and umbilical cord blood grafts were underrepresented in our cohort (≤11%). The cumulative incidence of late aGVHD (late onset and recurrent) was 10% at a median of 5.5 months post-HCT, that of cGVHD was 47% at a median of 7.4 months, that of bronchiolitis obliterans was 3% at a median of 12.2 months, and that of cutaneous sclerosis was 8% at a median onset of 14.0 months. Late aGVHD and bronchiolitis obliterans had particularly high nonrelapse mortality of 23% and 32%, respectively, by 2 years after diagnosis. The probability of late aGVHD- and cGVHD-free, relapse-free survival was 38% at 1 year post-HCT and 26% at 2 years post-HCT. This multicenter prospective study confirms the high rate of late aGVHD and cGVHD syndromes and supports the need for continuous close monitoring and development of more effective GVHD treatment strategies to improve HCT success.

Copyright © 2016 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

KEYWORDS:

Bronchiolitis obliterans syndrome; Chronic graft-versus-host disease; Cutaneous sclerosis; Graft-versus-host disease syndromes; Hematopoietic cell transplantation; Late acute graft-versus-host disease

PMID:
26541363
[PubMed - in process]
PMCID:
PMC4787270
[Available on 2017-03-01]
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