Format

Send to

Choose Destination
Haematologica. 2017 May;102(5):958-966. doi: 10.3324/haematol.2016.156356. Epub 2017 Mar 16.

Improved survival after acute graft-versus-host disease diagnosis in the modern era.

Author information

1
Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA.
2
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
3
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
4
Utah Blood and Marrow Transplant Program-Adults, Salt Lake City, UT, USA.
5
Department of Stem Cell Transplantation, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
6
Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
7
Department of Pediatric Hematology Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
8
Hematology Branch, National Heart, Lung and Blood Institute-NIH, Bethesda, MD, USA.
9
Department of Hematology, University Hospital, Grenoble, France.
10
Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA.
11
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
12
Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, UK.
13
Department of Internal Medicine, Mayo Clinic Rochester, MN, USA.
14
Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
15
Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, MO, USA.
16
Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
17
Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
18
Division of Hematology and Oncology, Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA.
19
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
20
Blood & Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
21
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
22
University Hospital of Leuven, Belgium.
23
Department of Hematology, Academische Ziekenhuis, Maastricht, the Netherlands.
24
Department of Hematology, Hopital Saint Louis, Paris, France.
25
Department of Medicine, University of Calgary, AB, Canada.
26
Isala Clinics Zwolle, the Netherlands.
27
Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO, USA.
28
Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
29
Division of Hematology/Oncology & HSCT, The Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, LA, USA.
30
Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
31
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
32
Cincinnati Children's Hospital Medical Center, OH, USA.
33
Hematologic Malignancies & Bone Marrow Transplant, Department of Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical Center, NY, USA.
34
The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, GA, USA.
35
Dana Farber Cancer Institute/Boston Children's Hospital, MA, USA.
36
Department of Pediatric Hematology, Oncology and Bone Marrow Transplant, British Columbia's Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.
37
Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, WA, USA.
38
CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be the Match, Minneapolis, MN, USA.
39
Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
40
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA joseph.pidala@moffitt.org.

Abstract

A cute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft-versus-host disease. We examined outcome following diagnosis of grade II-IV acute graft-versus-host disease according to time period, and explored effects according to original graft-versus-host disease prophylaxis regimen and maximum overall grade of acute graft-versus-host disease. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic leukemia (30%) or myelodysplastic syndromes (14%) received a sibling (24%) or unrelated donor (76%) blood (66%) or marrow (34%) transplant and developed grade II-IV acute graft-versus-host disease (n=497 for 1999-2001, n=962 for 2002-2005, n=1,446 for 2006-2010). The median (range) follow-up was 144 (4-174), 97 (4-147) and 60 (8-99) months for 1999-2001, 2002-2005, and 2006-2010, respectively. Among the cohort with grade II-IV acute graft-versus-host disease, there was a decrease in the proportion of grade III-IV disease over time with 56%, 47%, and 37% for 1999-2001, 2002-2005, and 2006-2012, respectively (P<0.001). Considering the total study population, univariate analysis demonstrated significant improvements in overall survival and treatment-related mortality over time, and deaths from organ failure and infection declined. On multivariate analysis, significant improvements in overall survival (P=0.003) and treatment-related mortality (P=0.008) were only noted among those originally treated with tacrolimus-based graft-versus-host disease prophylaxis, and these effects were most apparent among those with overall grade II acute graft-versus-host disease. In conclusion, survival has improved over time for tacrolimus-treated transplant recipients with acute graft-versus-host disease.

PMID:
28302712
PMCID:
PMC5477615
DOI:
10.3324/haematol.2016.156356
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center