Outcomes of chronic graft-versus-host disease following matched sibling donor versus umbilical cord blood transplant
- 8 January 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Bone Marrow Transplantation
- Vol. 56 (6), 1373-1380
- https://doi.org/10.1038/s41409-020-01195-5
Abstract
We compared chronic graft-versus-host disease (cGvHD) following umbilical cord blood (UCBT) and matched sibling donor peripheral blood transplant (MSD). 145 patients (2010–2017) with cGvHD after MSD (n = 104) and UCBT (n = 41) were included. Prior acute GvHD was less frequent in MSD (55% vs. 85%; p = 0.01). Severe cGvHD (32% vs. 15%, p = 0.01) and de-novo onset (45% vs. 15%, p < 0.01) were more frequent following MSD. Liver was more frequently involved in MSD recipients (38% vs. 6%); and GI in UCBT (33% vs. 63%), both p < 0.01. Overall response (CR + PR) was similar between both cohorts. 2-year CR was higher in UCBT (14% vs 33%, p = 0.02). Karnofsky score (KPS) ≥ 90 at cGvHD diagnosis was associated with higher odds of response (95%CI: 1.42–10, p < 0.01). The cumulative incidence of durable discontinuation of immune-suppressive therapy, failure-free survival (FFS) and NRM at 2-years were similar between cohorts. KPS < 90 (95%CI: 3.1–24.9, p < 0.01) and platelets p = 0.01) were associated with higher risk of NRM. UCBT patients were more likely to have a prior acute GvHD, less severe cGvHD and more likely to attain CR. Despite differences, both cohorts had similar NRM and FFS. High-risk groups, including those with platelets <100 × 10e9/L and KPS < 90, need careful monitoring and intensified therapy.Keywords
This publication has 23 references indexed in Scilit:
- Antithymocyte Globulin for Graft-Versus-Host Disease Prophylaxis After Allogeneic Hematopoietic Stem-Cell TransplantationJournal of Clinical Oncology, 2017
- Impact of Donor Epstein-Barr Virus Serostatus on the Incidence of Graft-Versus-Host Disease in Patients With Acute Leukemia After Hematopoietic Stem-Cell Transplantation: A Study From the Acute Leukemia and Infectious Diseases Working Parties of the European Society for Blood and Marrow TransplantationJournal of Clinical Oncology, 2016
- Multi-Institutional Study of Post-Transplantation Cyclophosphamide As Single-Agent Graft-Versus-Host Disease Prophylaxis After Allogeneic Bone Marrow Transplantation Using Myeloablative Busulfan and Fludarabine ConditioningJournal of Clinical Oncology, 2014
- Increasing Incidence of Chronic Graft-versus-Host Disease in Allogeneic Transplantation: A Report from the Center for International Blood and Marrow Transplant ResearchTransplantation and Cellular Therapy, 2014
- Failure-free survival after initial systemic treatment of chronic graft-versus-host diseaseBlood, 2014
- Characteristics of chronic GVHD after cord blood transplantationBone Marrow Transplantation, 2013
- Patient-reported quality of life is associated with severity of chronic graft-versus-host disease as measured by NIH criteria: report on baseline data from the Chronic GVHD ConsortiumBlood, 2011
- Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteriaBlood, 2011
- Graft-versus-host disease after donor leukocyte infusions: presentation and managementBest Practice & Research Clinical Haematology, 2008
- Chronic graft versus host diseaseBritish Journal of Haematology, 2004