Risk factors for acute GVHD and survival after hematopoietic cell transplantation

Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for Inter...

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Vydáno v:Blood Ročník 119; číslo 1; s. 296
Hlavní autoři: Jagasia, Madan, Arora, Mukta, Flowers, Mary E D, Chao, Nelson J, McCarthy, Philip L, Cutler, Corey S, Urbano-Ispizua, Alvaro, Pavletic, Steven Z, Haagenson, Michael D, Zhang, Mei-Jie, Antin, Joseph H, Bolwell, Brian J, Bredeson, Christopher, Cahn, Jean-Yves, Cairo, Mitchell, Gale, Robert Peter, Gupta, Vikas, Lee, Stephanie J, Litzow, Mark, Weisdorf, Daniel J, Horowitz, Mary M, Hahn, Theresa
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 05.01.2012
Témata:
Acute Disease
Adolescent
Adult
Aged
Child
Child, Preschool
Female
Graft vs Host Disease - etiology
Graft vs Host Disease - mortality
Hematologic Neoplasms - complications
Hematologic Neoplasms - mortality
Hematologic Neoplasms - therapy
Hematopoietic Stem Cell Transplantation - adverse effects
Histocompatibility
Humans
Infant
Male
Middle Aged
Retrospective Studies
Risk Factors
Siblings
Survival Rate
Tissue Donors
Transplantation Conditioning
Transplantation, Homologous
Unrelated Donors
Whole-Body Irradiation
Young Adult
ISSN:1528-0020, 1528-0020
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Shrnutí:Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for International Blood and Marrow Transplant Research, Minneapolis, MN. To understand the impact of transplant regimen on AGVHD risk, 6 treatment categories were evaluated: (1) myeloablative conditioning (MA) with total body irradiation (TBI) + PBSCs, (2) MA + TBI + BM, (3) MA + nonTBI + PBSCs, (4) MA + nonTBI + BM, (5) reduced intensity conditioning (RIC) + PBSCs, and (6) RIC + BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval [CI], 37%-41%) in the SD cohort and 59% (95% CI, 57%-61%) in the URD cohort. Patients receiving SD transplants with MA + nonTBI + BM and RIC + PBSCs had significantly lower risks of grades B-D AGVHD than patients in other treatment categories. Those receiving URD transplants with MA + TBI + BM, MA + nonTBI + BM, RIC + BM, or RIC + PBSCs had lower risks of grades B-D AGVHD than those in other treatment categories. The 5-year probabilities of survival were 46% (95% CI, 44%-49%) with SD transplants and 33% (95% CI, 31%-35%) with URD transplants. Conditioning intensity, TBI and graft source have a combined effect on risk of AGVHD that must be considered in deciding on a treatment strategy for individual patients.
Bibliografie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:1528-0020
1528-0020
DOI:10.1182/blood-2011-06-364265