Prognostic relevance of ‘early‐onset’ graft‐versus‐host disease following non‐myeloablative haematopoietic cell transplantation
Open Access
- 19 April 2005
- journal article
- Published by Wiley in British Journal of Haematology
- Vol. 129 (3), 381-391
- https://doi.org/10.1111/j.1365-2141.2005.05458.x
Abstract
We retrospectively analysed outcomes among 395 patients with haematologic malignancies who underwent non‐myeloablative haematopoietic cell transplantation (HCT) from human leucocyte antigen (HLA)‐matched related (n = 297) or unrelated donors (n = 98) in order to identify a possible correlation between the time of onset of graft‐versus‐host disease (GVHD) and survival. The non‐myeloablative regimen consisted of 2 Gy total body irradiation with or without fludarabine, followed by postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. The cumulative incidences of grades II–IV acute GVHD and extensive chronic GVHD were 45% and 47%, respectively, with related donors, and 68% and 68%, respectively, with unrelated donors. High‐dose corticosteroid treatment for acute or chronic GVHD was started at a median of 79 (range, 8–799) days and 30 (range, 5–333) days after transplantation from related and unrelated donors respectively. With related donors, the cumulative incidence of non‐relapse mortality among patients with GVHD was 55% at 4 years when prednisone was started before day 50 (n = 72), compared with 29% when treatment was started after day 50 (n = 115) (P < 0·001). With unrelated donors, time to onset of treatment for GVHD was not associated with survival. Patients with early‐onset GVHD after non‐myeloablative HCT from HLA‐identical related donors might benefit from intensified primary immunosuppressive treatment.Keywords
This publication has 37 references indexed in Scilit:
- Morbidity and mortality with nonmyeloablative compared with myeloablative conditioning before hematopoietic cell transplantation from HLA-matched related donorsBlood, 2004
- Successful use of Campath-1H in the treatment of steroid refractory liver GvHDBone Marrow Transplantation, 2004
- Acute and chronic graft-versus-host disease after ablative and nonmyeloablative conditioning for allogeneic hematopoietic transplantationTransplantation and Cellular Therapy, 2004
- HLA-matched unrelated donor hematopoietic cell transplantation after nonmyeloablative conditioning for patients with hematologic malignanciesBlood, 2003
- Tumor necrosis factor- alpha production to lipopolysaccharide stimulation by donor cells predicts the severity of experimental acute graft-versus-host disease.JCI Insight, 1998
- Macrophage priming and lipopolysaccharide-triggered release of tumor necrosis factor alpha during graft-versus-host disease.The Journal of Experimental Medicine, 1992
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validationJournal of Chronic Diseases, 1987
- Assessing illness severity: Does clinical judgment work?Journal of Chronic Diseases, 1986
- Antileukemic Effect of Graft-versus-Host Disease in Human Recipients of Allogeneic-Marrow GraftsNew England Journal of Medicine, 1979
- CLINICAL MANIFESTATIONS OF GRAFT-VERSUS-HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL-A-MATCHED SIBLING DONOR,STransplantation, 1974