Graft-versus-host disease induced graft-versus-leukemia effect: greater impact on relapse and disease-free survival after reduced intensity conditioning. Biol Blood Marrow Transplant 2012 Nov;18(11):1727-33
Date
07/07/2012Pubmed ID
22766220Pubmed Central ID
PMC3472079DOI
10.1016/j.bbmt.2012.06.014Scopus ID
2-s2.0-84867505772 (requires institutional sign-in at Scopus site) 134 CitationsAbstract
We studied graft-versus-host disease (GVHD) on relapse, transplant-related mortality (TRM), disease-free survival (DFS), and overall survival (OS) after allogeneic transplantation for acute myelogenous leukemia (AML) (n = 4224) and myelodysplastic syndrome (MDS) (n = 1517) in 4 groups: without GVHD, acute GVHD (aGVHD) alone, chronic GVHD (cGVHD) alone, and aGVHD + cGVHD. Examining GVHD as a time-dependent covariate, after myeloablative conditioning (MAC), cGVHD and aGVHD + cGVHD were associated with lower relapse (P < .002). TRM was higher in all GVHD groups (P < .0001); DFS and OS were lower with aGVHD ± cGVHD (P < .0001). After reduced-intensity conditioning (RIC), relapse was lower in all GVHD groups (P < .0001); TRM was increased and DFS and OS were reduced with any GVHD (P < .0001). In those surviving disease-free (≥1-year) after MAC, relapse risks were similar in all groups and TRM was higher with any GVHD (P < .0001). DFS and OS were lower with cGVHD and aGVHD + cGVHD (P < .0006). After RIC, relapse was lower (P = .009) and TRM higher (P = .002) only with aGVHD + cGVHD. DFS was similar in all groups and OS worse with aGVHD + cGVHD. After MAC, GVHD has an adverse effect on TRM with early modest augmentation of GVHD-associated graft-versus-leukemia (GVL). With RIC, GVHD-associated GVL may be important in limiting both early and late leukemia recurrence.
Author List
Weisdorf D, Zhang MJ, Arora M, Horowitz MM, Rizzo JD, Eapen MAuthors
Mary Eapen MBChB, MS Professor in the Medicine department at Medical College of WisconsinMary M. Horowitz MS, MD Adjunct Professor in the Medicine department at Medical College of Wisconsin
J. Douglas Rizzo MS, MD Director, Center Associate Director, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD, MS Emeritus Professor in the Data Science Institute department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
Acute DiseaseAdolescent
Adult
Aged
Child
Chronic Disease
Disease-Free Survival
Female
Graft vs Host Disease
Graft vs Leukemia Effect
Hematopoietic Stem Cell Transplantation
Humans
Leukemia, Myeloid, Acute
Male
Middle Aged
Myeloablative Agonists
Myelodysplastic Syndromes
Prospective Studies
Recurrence
Transplantation Conditioning
Transplantation, Homologous
