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Clinical Trial
. 2016 Mar;22(3):449-55.
doi: 10.1016/j.bbmt.2015.10.018. Epub 2015 Nov 2.

Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation

Mukta Arora  1 , Corey S Cutler  2 , Madan H Jagasia  3 , Joseph Pidala  4 , Xiaoyu Chai  5 , Paul J Martin  5 , Mary E D Flowers  5 , Yoshihiro Inamoto  6 , George L Chen  7 , William A Wood  8 , Nandita Khera  9 , Jeanne Palmer  9 , Hien Duong  10 , Sally Arai  11 , Sebastian Mayer  12 , Iskra Pusic  13 , Stephanie J Lee  5
Affiliations
Clinical Trial

Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation

Mukta Arora et al. Biol Blood Marrow Transplant. 2016 Mar.

Abstract

Several distinct graft-versus-host disease (GVHD)-related syndromes have been defined by the National Institutes of Health Consensus Conference. We enrolled a prospective cohort of 911 hematopoietic cell transplantation (HCT) recipients at 13 centers between March 2011 and May 2014 to evaluate 4 GVHD syndromes: late acute GVHD (aGVHD), chronic GVHD (cGVHD), bronchiolitis obliterans syndrome, and cutaneous sclerosis. The median age at HCT was 53.7 years. The majority of patients received a peripheral blood stem cell transplant (81%) following nonmyeloablative or reduced-intensity conditioning (55%). Pediatric age group and use of bone marrow and umbilical cord blood grafts were underrepresented in our cohort (≤11%). The cumulative incidence of late aGVHD (late onset and recurrent) was 10% at a median of 5.5 months post-HCT, that of cGVHD was 47% at a median of 7.4 months, that of bronchiolitis obliterans was 3% at a median of 12.2 months, and that of cutaneous sclerosis was 8% at a median onset of 14.0 months. Late aGVHD and bronchiolitis obliterans had particularly high nonrelapse mortality of 23% and 32%, respectively, by 2 years after diagnosis. The probability of late aGVHD- and cGVHD-free, relapse-free survival was 38% at 1 year post-HCT and 26% at 2 years post-HCT. This multicenter prospective study confirms the high rate of late aGVHD and cGVHD syndromes and supports the need for continuous close monitoring and development of more effective GVHD treatment strategies to improve HCT success.

Keywords: Bronchiolitis obliterans syndrome; Chronic graft-versus-host disease; Cutaneous sclerosis; Graft-versus-host disease syndromes; Hematopoietic cell transplantation; Late acute graft-versus-host disease.

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Conflict of interest statement

Conflict-of-interest disclosure

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1
Cumulative Incidence of late GVHD syndromes A: Late acute GVHD, B: Chronic GVHD, C: Bronchiolitis obliterans syndrome, D: Cutaneous sclerosis
Figure 2
Figure 2
Organ involvement amongst patients with chronic GVHD
Figure 3
Figure 3
GVHD-free-relapse-free-survival including only late acute and chronic GVHD syndromes
See this image and copyright information in PMC

References

    1. Fraser CJ, Bhatia S, Ness K, Carter A, Francisco L, Arora M, et al. Impact of chronic graft-versus-host disease on the health status of hematopoietic cell transplantation survivors: a report from the Bone Marrow Transplant Survivor Study. Blood. 2006 Oct 15;108(8):2867–2873. - PMC - PubMed
    1. Socie G, Stone JV, Wingard JR, Weisdorf D, Henslee-Downey PJ, Bredeson C, et al. Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med. 1999;341(1):14–21. - PubMed
    1. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2005 Dec;11(12):945–956. - PubMed
    1. Jagasia MH, Greinix HT, Arora M, Williams KM, Wolff D, Cowen EW, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2014 Dec 18; - PMC - PubMed
    1. Gooley TALW, Crowley J, Storer BE. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med. 1999;18(6):695–706. - PubMed

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