GvHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes
Por:
Chen, YB, Wang, T, Hemmer, MT, Brady, C, Couriel, DR, Alousi, A, Pidala, J, Urbano-Ispizua, A, Choi, SW, Nishihori, T, Teshima, T, Inamoto, Y, Wirk, B, Marks, DI, Abdel-Azim, H, Lehmann, L, Yu, L, Bitan, M, Cairo, MS, Qayed, M, Salit, R, Gale, RP, Martino, R, Jaglowski, S, Bajel, A, Savani, B, Frangoul, H, Lewis, ID, Storek, J, Askar, M, Kharfan-Dabaja, MA, Aljurf, M, Ringden, O, Reshef, R, Olsson, RF, Hashmi, S, Seo, S, Spitzer, TR, MacMillan, ML, Lazaryan, A, Spellman, SR, Arora, M, Cutler, CS
Publicada:
1 mar 2017
Resumen:
Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1404 umbilical cord blood transplantation (UCBT) patients (single (>= 18 years) = 810, double (< 18 years) = 594) with acute leukemia to define the incidence of acute GvHD (aGvHD) and chronic GvHD (cGvHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grade II-IV aGvHD was 39% (95% confidence interval (CI), 36-43%), grade III-IV aGvHD was 18% (95% CI, 15-20%) and 1-year cGvHD was 27% (95% CI, 24-30%). After double UCBT, 100-day incidence of grade II-IV aGvHD was 45% (95% CI, 41-49%), grade III-IV aGvHD was 22% (95% CI, 19-26%) and 1-year cGvHD was 26% (95% CI, 22-29%). For single UCBT, multivariate analysis showed that absence of antithymocyte globulin (ATG) was associated with aGvHD, whereas prior aGvHD was associated with cGvHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGvHD, whereas prior aGvHD predicted for cGvHD. Grade III-IV aGvHD led to worse survival, whereas cGvHD had no significant effect on disease-free or overall survival. GvHD is prevalent after UCBT with severe aGvHD leading to higher mortality. Future research in UCBT should prioritize prevention of GvHD.
Filiaciones:
Chen, YB:
Massachusetts Gen Hosp, Yawkey 9E 9052 55 Fruit St, Boston, MA 02114 USA
Wang, T:
Med Coll Wisconsin, Ctr Int Blood, Marrow Transplant Res, Dept Med, Milwaukee, WI USA
Med Coll Wisconsin, Div Biostat, Inst Hlth & Soc, Milwaukee, WI USA
Hemmer, MT:
Med Coll Wisconsin, Ctr Int Blood, Marrow Transplant Res, Dept Med, Milwaukee, WI USA
Brady, C:
Natl Marrow Donor Program Be Match, Ctr Int Blood, Marrow Transplant Res, Minneapolis, MN USA
Couriel, DR:
Marrow Transplant Program, Utah Blood, Salt Lake City, UT USA
Alousi, A:
Univ Texas MD Anderson Canc Ctr, Div Canc Med, Dept Stem Cell Transplantat, Houston, TX 77030 USA
Pidala, J:
H Lee Moffitt Canc Ctr & Res Inst, Res Inst, Tampa, FL USA
Urbano-Ispizua, A:
Univ Barcelona, IDIBAPS, Hosp Clin, Barcelona, Spain
Univ Barcelona, Inst Res Josep Carreras, Dept Hematol, Hosp Clin, Barcelona, Spain
Choi, SW:
Univ Michigan, Ann Arbor, MI 48109 USA
Nishihori, T:
H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Teshima, T:
Univ Hosp, Fukuoka, Japan
Inamoto, Y:
Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan
Wirk, B:
Seattle Canc Care Alliance, Div Bone Marrow Transplant, Seattle, WA USA
Marks, DI:
Univ Hosp Bristol NHS Trust, Adult Bone Marrow Transplant, Bristol, Avon, England
Abdel-Azim, H:
Univ So Calif, Keck Sch Med, Marrow Transplantat, Div Hematol Oncol & Blood, Los Angeles, CA 90033 USA
Lehmann, L:
Boston Childrens Hosp, Dana Farber Canc Inst, Boston, MA USA
Yu, L:
Louisiana State Univ, Med Ctr, Div Hematol Oncol, Childrens Hosp,Ctr Canc & Blood Disorders,HSC, New Orleans, LA USA
Bitan, M:
Tel Aviv Sourasky Med Ctr, Tel Aviv, Dept Pediat Hematol Oncol, Tel Aviv, Israel
Cairo, MS:
New York Med Coll, Div Pediat Hematol Oncol, Stem Cell Transplantat, Dept Pediat, Valhalla, NY USA
Qayed, M:
Emory Univ, Sch Med, Dept Pediat, Atlanta, GA, Australia
Salit, R:
Fred Hutchinson Canc Res Ctr, Seattle, WA USA
Gale, RP:
Imperial Coll London, Hematol Res Ctr, Div Expt Med, Dept Med, London, England
Martino, R:
Hosp Santa Creu St Pau, Div Clin Hematol, Barcelona, Spain
Jaglowski, S:
Ohio State Univ, Med Ctr, Div Hematol, Columbus, OH 43210 USA
Bajel, A:
Royal Melbourne Hosp City Campus, Melbourne, Australia
Savani, B:
Vanderbilt Univ, Med Ctr, Div Hematol Oncol, Dept Med, Nashville, TN USA
Frangoul, H:
Vanderbilt Univ, Sch Med, Div Hematol Oncol, Dept Pediat, Nashville, TN USA
Lewis, ID:
Royal Adelaide Hosp, Haematol & Bone Marrow Transplant Unit, Adelaide, SA, Australia
Storek, J:
Univ Calgary, Dept Med, Calgary, AB, Canada
Askar, M:
Baylor Univ, Med Ctr, Dallas, TX USA
Kharfan-Dabaja, MA:
H Lee Mofitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplantat, Tampa, FL USA
Aljurf, M:
King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia
Ringden, O:
Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden
Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
Reshef, R:
Columbia Univ, Med Ctr, Blood & Marrow Transplantat Program, Columbia Ctr Translat Immunol, New York, NY USA
Olsson, RF:
Karolinska Inst, Div Therapeut Immunol, Dept Lab Med, Stockholm, Sweden
Uppsala Univ, Ctr Clin Res Sormland, Uppsala, Sweden
Hashmi, S:
Mayo Clin Rochester, Rochester, MN USA
Seo, S:
Nat Canc Res Ctr, East Hosp, Kashiwa, Chiba, Japan
MacMillan, ML:
Univ Minnesota, Med Ctr, Minneapolis, MN USA
Lazaryan, A:
Univ Minnesota, Med Ctr, Div Hematol Oncol, Dept Med, Minneapolis, MN USA
Cutler, CS:
Dana Farber Canc Inst, Ctr Hematol Oncol, Dept Med Oncol, Boston, MA USA
Green Accepted, Bronze
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