Long-term outcomes and risk factor analysis of steroid-refractory graft versus host disease after hematopoietic stem cell transplantation

被引:12
|
作者
Pagliuca, Simona [1 ,2 ,3 ]
Prata, Pedro Henrique [1 ]
Xhaard, Alienor [1 ]
Frieri, Camilla [1 ,2 ,4 ]
Giannoni, Livia [1 ]
del Galy, Aurelien Sutra [1 ,2 ]
Brignier, Anne [5 ]
de Fontbrune, Flore Sicre [1 ]
Michonneau, David [1 ,2 ,6 ]
Dhedin, Nathalie [1 ]
de Latour, Regis Peffault [1 ,2 ]
Socie, Gerard [1 ,2 ,6 ]
Robin, Marie [1 ]
机构
[1] St Louis Hosp, AP HP, Hematol & Transplantat Unit, Paris, France
[2] Univ Paris, Paris, France
[3] Cleveland Clin Fdn, Dept Translat Hematol & Oncol Res, 9500 Euclid Ave, Cleveland, OH 44195 USA
[4] Univ Naples Federico II, Dept Hematol & Transplantat, Naples, Italy
[5] St Louis Hosp, AP HP, Therapeut Apheresis Unit, Paris, France
[6] INSERM UMR 976, Paris, France
关键词
CONSENSUS DEVELOPMENT PROJECT; BONE-MARROW-TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; ACUTE LYMPHOBLASTIC-LEUKEMIA; MATCHED UNRELATED DONORS; TOTAL-BODY IRRADIATION; RELAPSE-FREE SURVIVAL; CLINICAL-TRIALS; EUROPEAN GROUP; WORKING PARTY;
D O I
10.1038/s41409-020-0977-3
中图分类号
Q6 [生物物理学];
学科分类号
071011 ;
摘要
Steroid-refractory graft versus host disease (GVHD) represents a fearsome complication after allogeneic hematopoietic stem cell transplantation (HSCT). We conducted a retrospective study on outcomes and risk factors associated with acute and chronic steroid-refractory GVHD in a large cohort of 1207 patients receiving HSCT in Saint Louis Hospital between 2007 and 2017. Among patients who developed an acute and/or a chronic GVHD, the cumulative incidences of acute and chronic steroid-refractory disease were 31% and 48%, respectively, at day +100 and 1-year post-HSCT. Through a multivariable analysis we selected several risk factors associated with the development of a steroid-refractory disease. For acute GVHD steroid refractoriness, we identified (1) a very high disease risk index, (2) an unrelated donor, (3) the absence of in vivo T-depletion as GVHD prophylaxis, and (4) a reduced intensity conditioning regimen. For chronic GVHD, (1) the use of peripheral blood stem cells, (2) unrelated donors, and (3) absence of in vivo T-depletion were more likely associated with a steroid-refractory disease. After the construction of a multistate dynamic model, we found that the probability of being alive without relapse after the resolution of all GVHD episodes was about 36% in the long term.
引用
收藏
页码:38 / 49
页数:12
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