Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European group for blood and marrow transplantation

被引:0
作者
F Baron
M Labopin
D Niederwieser
S Vigouroux
J J Cornelissen
C Malm
L L Vindelov
D Blaise
J J W M Janssen
E Petersen
G Socié
A Nagler
V Rocha
M Mohty
机构
[1] University of Liège,Department of Hematology
[2] Hopital Saint Antoine,Department of Hematology/Oncology and Hemostasiology
[3] Service d’Hématologie et Thérapie Cellulaire,Department of Blood Diseases
[4] University of Leipzig,Department of Hematology
[5] University Hospital and University Bordeaux 2,Department of Hematology
[6] Erasmus University Medical Center,Department of Hematology
[7] Linköping University Hospital,Department of Hematology
[8] Rigshospitalet,Department of Hematology
[9] CHU de Marseille,Department of Bone Marrow Transplantation
[10] VU University Medical Center,Hematology Division
[11] University Medical Centre Utrecht,Hematology Department
[12] Saint-Louis Hospital,undefined
[13] Tel-Aviv University,undefined
[14] Sheba Medical Center,undefined
[15] Eurocord,undefined
[16] EBMT ALWP,undefined
[17] CHU Hotel Dieu,undefined
[18] Université de Nantes,undefined
[19] Nantes,undefined
[20] France,undefined
[21] INSERM U892,undefined
[22] Nantes,undefined
[23] France,undefined
来源
Leukemia | 2012年 / 26卷
关键词
reduced-intensity conditioning; AML; GVHD; chronic; graft-versus-leukemia effects;
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学科分类号
摘要
This report investigated the impact of graft-versus-host disease (GVHD) on transplantation outcomes in 1859 acute myeloid leukemia patients given allogeneic peripheral blood stem cells after reduced-intensity conditioning (RIC allo-SCT). Grade I acute GVHD was associated with a lower risk of relapse (hazards ratio (HR)=0.7, P=0.02) translating into a trend for better overall survival (OS; HR=1.3; P=0.07). Grade II acute GVHD had no net impact on OS, while grade III–IV acute GVHD was associated with a worse OS (HR=0.4, P<0.0.001) owing to high risk of nonrelapse mortality (NRM; HR=5.2, P<0.0001). In time-dependent multivariate Cox analyses, limited chronic GVHD tended to be associated with a lower risk of relapse (HR=0.72; P=0.07) translating into a better OS (HR=1.8; P<0.001), while extensive chronic GVHD was associated with a lower risk of relapse (HR=0.65; P=0.02) but also with higher NRM (HR=3.5; P<0.001) and thus had no net impact on OS. In-vivo T-cell depletion with antithymocyte globulin (ATG) or alemtuzumab was successful at preventing extensive chronic GVHD (P<0.001), but without improving OS for ATG and even with worsening OS for alemtuzumab (HR=0.65; P=0.001). These results highlight the role of the immune-mediated graft-versus-leukemia effect in the RIC allo-SCT setting, but also the need for improving the prevention and treatment of severe GVHD.
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页码:2462 / 2468
页数:6
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