Medical College of Wisconsin
CTSICores SearchResearch InformaticsREDCap

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 PMID: 22766220 PMCID: PMC3472079

Pubmed ID

22766220

Abstract

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 M

Authors

Mary Eapen MBBS, DCh, MRCPI, MS Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin
J. Douglas D. Rizzo MD, MS Director, Ctr Associate Director, Professor in the Medicine department at Medical College of Wisconsin
Mei-Jie Zhang PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin




Scopus

2-s2.0-84867505772   65 Citations

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
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
jenkins-FCD Prod-300 626508253d14e4184314fb9f66322a03a5906796