Improved survival after acute graft-versus-host disease diagnosis in the modern era
Khoury, Hanna J. (Winship Cancer Institute of Emory University)
Wang, Tao (Medical College of Wisconsin)
Hemmer, Michael T. (Medical College of Wisconsin)
Couriel, Daniel (Utah Blood and Marrow Transplant)
Alousi, Amin (The University of Texas MD Anderson Cancer Center)
Cutler, Corey (Dana-Farber Cancer Institute (Boston, Estats Units d'Amèrica))
Aljurf, Mahmoud (King Faisal Specialist Hospital and Research Centre (Aràbia Saudita))
Battiwalla, Minoo (Lung and Blood Institute-NIH)
Cahn, Jean-Yves (University Hospital)
Cairo, Mitchell (New York Medical College)
Chen, Yi-Bin (Massachusetts General Hospital (Boston))
Gale, Robert Peter (Imperial College London)
Hashmi, Shahrukh (King Faisal Specialist Hospital and Research Centre (Aràbia Saudita))
Hayashi, Robert J. (Washington University School of Medicine in St. Louis)
Jagasia, Madan (Vanderbilt University Medical Center)
Juckett, Mark (University of Wisconsin Hospital and Clinics)
Kamble, Rammurti T. (Baylor College of Medicine)
Kharfan-Dabaja, Mohamed (H. Lee Moffitt Cancer Center and Research Institute)
Litzow, Mark (Mayo Clinic Rochester)
Majhail, Navnnet (Cleveland Clinic Taussig Cancer Institute)
Miller, Alan (Baylor College of Medicine)
Nishihori, Taiga (H. Lee Moffitt Cancer Center and Research Institute)
Qayed, Muna (Emory University School of Medicine)
Antin, Joseph H. (Dana-Farber Cancer Institute (Boston, Estats Units d'Amèrica))
Schoemans, Helene (University Hospitals Leuven (Bèlgica))
Schouten, Harry C. (Academische Ziekenhuis)
Socie, Gerard (Hopital Saint Louis)
Storek, Jan (University of Calgary)
Verdonck, Leo (Isala Clinics Zwolle)
Vij, Ravi (Washington University School of Medicine)
Wood, Willian A. (University of North Carolina)
Yu, Lolie (Children's Hospital/Louisiana State University Medical Center)
Martino Bofarull, Rodrigo (Institut d'Investigació Biomèdica Sant Pau)
Carabasi, Matthew (Thomas Jefferson University Hospital)
Dandoy, Christopher (Cincinnati Children's Hospital Medical Center)
Gergis, Usama (New York Presbyterian Hospital/Weill Cornell Medical Center)
Hematti, Peiman (University of Wisconsin Hospital and Clinics)
Solh, Melham (The Blood and Marrow Transplant Group of Georgia)
Jamani, Kareem (University of Calgary)
Lehmann, Leslie (Boston Children's Hospital (Boston, Estats Units d'Amèrica))
Savani, Bipin (Vanderbilt University Medical Center)
Schultz, Kirk R. (The University of British Columbia)
Wirk, Baldeep M. (Seattle Cancer Care Alliance)
Spellman, Stephen (Center for International Blood and Marrow Transplant Research)
Arora, Mukta (University of Minnesota Medical Center)
Pidala, Joseph (H. Lee Moffitt Cancer Center and Research Institute)
Universitat Autònoma de Barcelona

Data:	2017
Resum:	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 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Haematologica, Vol. 102 Núm. 5 (30 2017) , p. 958-966, ISSN 1592-8721

DOI: 10.3324/haematol.2016.156356
PMID: 28302712

9 p, 1.0 MB

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