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

被引：87

作者：

Khoury, Hanna J. ^{[1
]}

Wang, Tao ^{[2
,3
]}

Hemmer, Michael T. ^{[2
]}

Couriel, Daniel ^{[4
]}

Alousi, Amin ^{[5
]}

Cutler, Corey ^{[6
]}

Aljurf, Mahmoud ^{[7
]}

Antin, Joseph H. ^{[6
]}

Ayas, Mouhab ^{[7
]}

Battiwalla, Minoo ^{[8
]}

Cahn, Jean-Yves ^{[9
]}

Cairo, Mitchell ^{[10
]}

Chen, Yi-Bin ^{[11
]}

Gale, Robert Peter ^{[12
]}

Hashmi, Shahrukh ^{[13
,14
]}

Hayashi, Robert J. ^{[15
]}

Jagasia, Madan ^{[16
]}

Juckett, Mark ^{[17
]}

Kamble, Rammurti T. ^{[18
]}

Kharfan-Dabaja, Mohamed ^{[19
]}

Litzow, Mark ^{[13
]}

Majhail, Navneet ^{[20
]}

Miller, Alan ^{[18
]}

Nishihori, Taiga ^{[19
]}

Qayed, Muna ^{[21
]}

Schoemans, Helene ^{[22
]}

Schouten, Harry C. ^{[23
]}

Socie, Gerard ^{[24
]}

Storek, Jan ^{[25
]}

Verdonck, Leo ^{[26
]}

Vij, Ravi ^{[27
]}

Wood, William A. ^{[28
]}

Yu, Lolie ^{[29
]}

Martino, Rodrigo ^{[30
]}

Carabasi, Matthew ^{[31
]}

Dandoy, Christopher ^{[32
]}

Gergis, Usama ^{[33
]}

Hematti, Peiman ^{[17
]}

Solh, Melham ^{[34
]}

Jamani, Kareem ^{[25
]}

Lehmann, Leslie ^{[35
]}

Savani, Bipin ^{[16
]}

Schultz, Kirk R. ^{[36
]}

Wirk, Baldeep M. ^{[37
]}

Spellman, Stephen ^{[38
]}

Arora, Mukta ^{[39
]}

Pidala, Joseph ^{[19
]}

机构：

[1] Emory Univ, Winship Canc Inst, Dept Hematol & Med Oncol, Atlanta, GA 30322 USA

[2] Med Coll Wisconsin, Dept Med, CIBMTR Ctr Int Blood & Marrow Transplant Res, Milwaukee, WI 53226 USA

[3] Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI 53226 USA

[4] Utah Blood & Marrow Transplant Program Adults, Salt Lake City, UT USA

[5] Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX 77030 USA

[6] Dana Farber Canc Inst, Dept Med Oncol, Ctr Hematol Oncol, Boston, MA 02115 USA

[7] King Faisal Specialist Hosp Ctr & Res, Dept Pediat Hematol Oncol, Riyadh, Saudi Arabia

[8] NHLBI, Hematol Branch, NIH, Bethesda, MD 20892 USA

[9] Univ Hosp, Dept Hematol, Grenoble, France

[10] New York Med Coll, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, Valhalla, NY 10595 USA

[11] Massachusetts Gen Hosp, Div Hematol Oncol, Boston, MA 02114 USA

[12] Imperial Coll London, Div Expt Med, Dept Med, Hematol Res Ctr, London, England

[13] Mayo Clin Rochester, Dept Internal Med, Rochester, MN USA

[14] King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia

[15] Washington Univ, Dept Pediat, Sch Med St Louis, Div Pediat Hematol Oncol, St Louis, MO 63130 USA

[16] Vanderbilt Univ, Med Ctr, Div Hematol Oncol, Nashville, TN USA

[17] Univ Wisconsin Hosp & Clin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI 53792 USA

[18] Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA

[19] H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL 33612 USA

[20] Cleveland Clin, Blood & Marrow Transplant Program, Taussig Canc Inst, Cleveland, OH 44106 USA

[21] Emory Univ, Sch Med, Dept Pediat, Atlanta, GA USA

[22] Univ Hosp Leuven, Leuven, Belgium

[23] Acad Ziekenhuis, Dept Hematol, Maastricht, Netherlands

[24] Hop St Louis, Dept Hematol, Paris, France

[25] Univ Calgary, Dept Med, Calgary, AB, Canada

[26] Isala Clin Zwolle, Zwolle, Netherlands

[27] Washington Univ, Sch Med, Div Hematol & Oncol, St Louis, MO USA

[28] Univ N Carolina, Dept Med, Div Hematol Oncol, Chapel Hill, NC USA

[29] Louisiana State Univ, Med Ctr, Childrens Hosp, Div Hematol Oncol & HSCT,Ctr Canc & Blood Disorde, New Orleans, LA USA

[30] Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain

[31] Thomas Jefferson Univ Hosp, Philadelphia, PA 19107 USA

[32] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA

[33] New York Presbyterian Hosp, Weill Cornell Med Ctr, Dept Med Oncol, Hematol Malignancies & Bone Marrow Transplant, New York, NY USA

[34] Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA

[35] Boston Childrens Hosp, Dana Farber Canc Inst, Boston, MA USA

[36] Univ British Columbia, British Columbias Childrens Hosp, Dept Pediat Hematol Oncol & Bone Marrow Transplan, Vancouver, BC, Canada

[37] Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA

[38] Natl Marrow Donor Program Be Match, CIBMTR Ctr Int Blood & Marrow Transplant Res, Minneapolis, MN USA

[39] Univ Minnesota, Med Ctr, Dept Med, Div Hematol Oncol & Transplantat, Minneapolis, MN 55455 USA

来源：

HAEMATOLOGICA | 2017年 / 102卷 / 05期

关键词：

HEMATOPOIETIC-CELL TRANSPLANTATION; COMPARING METHOTREXATE; MARROW-TRANSPLANTATION; UNRELATED DONORS; RISK SCORE; GVHD; PROPHYLAXIS; CYCLOSPORINE; TACROLIMUS; MORTALITY;

D O I：

10.3324/haematol.2016.156356

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Acute 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 19992001, 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.

引用

页码：958 / 966

页数：9

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