Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study

被引：25

作者：

Itonaga, Hidehiro ^{[1
,2
]}

Iwanaga, Masako ^{[3
]}

Aoki, Kazunari ^{[4
]}

Aoki, Jun ^{[5
]}

Ishiyama, Ken ^{[6
]}

Ishikawa, Takayuki ^{[7
]}

Sakura, Toru ^{[8
]}

Fukuda, Takahiro ^{[9
]}

Najima, Yuho ^{[10
]}

Yujiri, Toshiaki ^{[11
]}

Mori, Takehiko ^{[12
]}

Kurokawa, Mineo ^{[13
]}

Nawa, Yuichiro ^{[14
]}

Uchida, Naoyuki ^{[15
]}

Morishita, Yoshihisa ^{[16
]}

Hashimoto, Hisako ^{[17
]}

Eto, Tetsuya ^{[18
]}

Hirokawa, Makoto ^{[19
]}

Morishima, Yasuo ^{[20
]}

Nagamura-Inoue, Tokiko ^{[21
]}

Atsuta, Yoshiko ^{[22
,23
]}

Miyazaki, Yasushi ^{[2
]}

机构：

[1] Sasebo City Gen Hosp, Dept Hematol, Sasebo, Japan

[2] Nagasaki Univ, Atom Bomb Dis Inst, Atom Bomb Dis & Hibakusha Med Unit, Dept Hematol, Nagasaki 852, Japan

[3] Nagasaki Univ, Grad Sch Biomed Sci, Dept Frontier Life Sci, Nagasaki 852, Japan

[4] Kyoto Univ, Grad Sch Med, Dept Hematol & Oncol, Kyoto, Japan

[5] Kanagawa Canc Ctr, Dept Hematol, 1-1-2 Nakao, Yokohama, Kanagawa 2410815, Japan

[6] Kanazawa Univ Hosp, Dept Hematol, Kanazawa, Ishikawa, Japan

[7] Kobe City Gen Hosp, Dept Hematol, Kobe, Hyogo, Japan

[8] Saiseikai Maebashi Hosp, Leukemia Res Ctr, Maebashi, Gunma, Japan

[9] Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, 1-1 Tsukiji 5 chome, Tokyo, Japan

[10] Tokyo Metropolitan Komagome Hosp, Div Hematol, Dept Internal Med, Tokyo, Japan

[11] Yamaguchi Univ, Dept Internal Med 3, Ube, Yamaguchi 755, Japan

[12] Keio Univ, Sch Med, Dept Med, Div Hematol, Tokyo 160, Japan

[13] Univ Tokyo, Grad Sch Med, Dept Hematol & Oncol, Tokyo 1138654, Japan

[14] Ehime Prefectural Cent Hosp, Div Hematol, Matsuyama, Ehime, Japan

[15] Federat Natl Publ Serv Personnel Mutual Aid Assoc, Toranomon Hosp, Dept Hematol, Tokyo, Japan

[16] JA Aichi Konan Kosei Hosp, Div Hematol & Oncol, Konan, Aichi, Japan

[17] Kobe Gen Hosp, Inst Biomed Res & Innovat, Div Stem Cell Transplantat, Dept Hematol, Kobe, Hyogo, Japan

[18] Hamanomachi Hosp, Dept Hematol, Fukuoka, Japan

[19] Akita Univ Hosp, Clin Oncol Ctr, Akita, Japan

[20] Aichi Canc Ctr, Res Inst, Div Epidemiol & Prevent, Nagoya, Aichi 464, Japan

[21] Univ Tokyo, Inst Med Sci, Res Hosp, Dept Cell Proc & Transfus, Tokyo, Japan

[22] Nagoya Univ, Grad Sch Med, Japanese Data Ctr Hematopoiet Stem Cell Transplan, Nagoya, Aichi 4648601, Japan

[23] Nagoya Univ, Grad Sch Med, Dept Healthcare Adm, Nagoya, Aichi 4648601, Japan

来源：

LEUKEMIA RESEARCH | 2016年 / 41卷

关键词：

Chronic myelomonocytic leukemia; Allogeneic hematopoietic stem cell transplantation; Graft-versus-host disease; Graft-versus-leukemia effect; BONE-MARROW-TRANSPLANTATION; HLA-IDENTICAL SIBLINGS; ACUTE MYELOID-LEUKEMIA; MYELODYSPLASTIC SYNDROME; INTERNATIONAL BLOOD; SCORING SYSTEM; CHRONIC GVHD; RELAPSE; DONORS; AZACITIDINE;

D O I：

10.1016/j.leukres.2015.12.009

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a therapeutic option that may lead to improved outcomes in patients with chronic myelomonocytic leukemia (CMML). However, few studies have examined the impact of the grade of graft-versus-host disease (GVHD) on post-transplant outcomes for CMML. We retrospectively analyzed the outcomes of 141 patients with CMML who underwent allo-HSCT between 1987 and 2010, and achieved neutrophil engraftment. The effects of acute GVHD (aGVHD) or chronic GVHD (cGVHD) on overall survival (OS), leukemia -associated mortality (LAM), and transplant-related mortality were evaluated by hazards regression models, in which the onset date of aGVHD or cGVHD was treated as a time-dependent covariate. Grade I aGVHD was associated with better OS and lower LAM (P=0.042, P=0.033, respectively) than no GVHD in univariate analyses, but not in the multivariate analyses. The multivariate analyses demonstrated that extensive cGVHD significantly associated with better OS (Hazard Ratio [HR] 0.35 [95% confidence intervals (CI), 0.16-0.74]; P= 0.007) and lower LAM (HR 0.36 [95% CI, 0.14-0.92]; P = 0.033) in patients who were not in complete remission at transplantation. In conclusion, the occurrence of cGVHD may be an important factor affecting the outcomes of CMML patients who received transplantation. (C) 2015 Elsevier Ltd. All rights reserved.

引用

页码：48 / 55

页数：8

共 52 条

[1] Development of a prognostic model for grading chronic graft-versus-host disease [J].

Akpek, G ;

Zahurak, ML ;

Piantadosi, S ;

Margolis, J ;

Doherty, J ;

Davidson, R ;

Vogelsang, GB .

BLOOD, 2001, 97 (05) :1219-1226

[2]

[Anonymous], 2008, WHO CLASSIFICATION T

[3] Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis [J].

Arora, Mukta ;

Klein, John P. ;

Weisdorf, Daniel J. ;

Hassebroek, Anna ;

Flowers, Mary E. D. ;

Cutler, Corey S. ;

Urbano-Ispizua, Alvaro ;

Antin, Joseph H. ;

Bolwell, Brian J. ;

Boyiadzis, Michael ;

Cahn, Jean-Yves ;

Cairo, Mitchell S. ;

Isola, Luis ;

Jacobsohn, David A. ;

Jagasia, Madan ;

Klumpp, Thomas R. ;

Lee, Stephanie J. ;

Petersdorf, Effie W. ;

Santarone, Stella ;

Gale, Robert Peter ;

Schouten, Harry C. ;

Spellman, Stephen ;

Wingard, John R. ;

Horowitz, Mary M. ;

Pavletic, Steven Z. .

BLOOD, 2011, 117 (24) :6714-6720

[4] Unification of hematopoietic stem cell transplantation registries in Japan and establishment of the TRUMP system [J].

Atsuta, Yoshiko ;

Suzuki, Ritsuro ;

Yoshimi, Ayami ;

Gondo, Hisashi ;

Tanaka, Junji ;

Hiraoka, Akira ;

Kato, Koji ;

Tabuchi, Ken ;

Tsuchida, Masahiro ;

Morishima, Yasuo ;

Mitamura, Makoto ;

Kawa, Keisei ;

Kato, Shunichi ;

Nagamura, Tokiko ;

Takanashi, Minoko ;

Kodera, Yoshihisa .

INTERNATIONAL JOURNAL OF HEMATOLOGY, 2007, 86 (03) :269-274

[5] Graft-versus-tumor effects after allogeneic hematopoietic cell transplantation with nonmyeloablative conditioning [J].

Baron, F ;

Maris, MB ;

Sandmaier, BM ;

Storer, BE ;

Sorror, M ;

Diaconescu, R ;

Woolfrey, AE ;

Chauncey, TR ;

Flowers, MED ;

Mielcarck, M ;

Maloney, DG ;

Storb, R .

JOURNAL OF CLINICAL ONCOLOGY, 2005, 23 (09) :1993-2003

[6] Topotecan and cytarabine is an active combination regimen in myelodysplastic syndromes and chronic myelomonocytic leukemia [J].

Beran, M ;

Estey, E ;

O'Brien, S ;

Cortes, J ;

Koller, CA ;

Giles, FJ ;

Kornblau, S ;

Andreeff, M ;

Vey, N ;

Pierce, SR ;

Hayes, K ;

Wong, GC ;

Keating, M ;

Kantarjian, H .

JOURNAL OF CLINICAL ONCOLOGY, 1999, 17 (09) :2819-2830

[7]

Beran M, 2000, INT J HEMATOL, V72, P139

[8] Current status of allogeneic HST for chronic myelomonocytic leukemia [J].

Cheng, H. ;

Kirtani, V. G. ;

Gergis, U. .

BONE MARROW TRANSPLANTATION, 2012, 47 (04) :535-541

[9] Competing Risks and Time-Dependent Covariates [J].

Cortese, Giuliana ;

Andersen, Per K. .

BIOMETRICAL JOURNAL, 2010, 52 (01) :138-158

[10] Activity of Azacitidine in Chronic Myelomonocytic Leukemia [J].

Costa, Rubens ;

Abdulhaq, Haifaa ;

Haq, Bushra ;

Shadduck, Richard K. ;

Latsko, Joan ;

Zenati, Mazen ;

Atem, Folefac D. ;

Rossetti, James M. ;

Sahovic, Entezam A. ;

Lister, John .

CANCER, 2011, 117 (12) :2690-2696

← 1 2 3 4 5 6 →