Effects of Acute and Chronic Graft-versus-myelodysplastic Syndrome on Long-term Outcomes Following Allogeneic Hematopoietic Cell Transplantation.

Autor:	Konuma T; Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. tkonuma@ims.u-tokyo.ac.jp., Ishiyama K; Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan., Igarashi A; Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan., Uchida N; Department of Hematology, Toranomon Hospital, Tokyo, Japan., Ozawa Y; Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan., Fukuda T; Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan., Ueda Y; Department of Hematology and Oncology, Kurashiki Central Hospital, Kurashiki, Japan., Matsuoka KI; Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan., Mori T; Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan., Katayama Y; Department of Hematology, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan., Onizuka M; Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan., Ichinohe T; Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan., Atsuta Y
Jazyk:	angličtina
Zdroj:	Clinical cancer research : an official journal of the American Association for Cancer Research [Clin Cancer Res] 2020 Dec 15; Vol. 26 (24), pp. 6483-6493. Date of Electronic Publication: 2020 Sep 06.
DOI:	10.1158/1078-0432.CCR-20-1104
Abstrakt:	Purpose: Potent graft-versus-tumor (GVT) effects associated with graft-versus-host disease (GVHD) might be dependent on hematologic disease type and status. However, the data regarding the impact of GVHD on transplant outcomes for patients with myelodysplastic syndrome (MDS) are limited. Experimental Design: We retrospectively evaluated the impact of acute and chronic GVHD on transplant outcomes for a large cohort of adult patients with a low-risk ( n = 1,193) and high-risk ( n = 1,926) MDS treated by first allogeneic hematopoietic cell transplantation between 2001 and 2017. Results: The multivariate analysis, in which development of GVHD was treated as a time-dependent covariate, showed that acute and chronic GVHD at any grade or severity did not improve overall mortality, relapse, or nonrelapse mortality (NRM) in low-risk MDS. For patients with high-risk MDS, development of limited chronic GVHD was significantly associated with lower overall mortality [HR, 0.66; 95% confidence interval (CI), 0.50-0.86; P = 0.002]. This is probably due to that the reduced risk of relapse with grade III-IV acute GVHD (HR, 0.41; 95% CI, 0.25-0.65; P = 0.0002), or limited (HR, 0.57; 95% CI, 0.39-0.83; P = 0.003) or extensive (HR, 0.56; 95% CI, 0.41-0.77; P = 0.0004) chronic GVHD was offset by increased NRM with grade III-IV acute GVHD or extensive chronic GVHD in high-risk MDS. Conclusions: These data demonstrated a survival benefit of the graft-versus-MDS effect is present only in high-risk MDS patients with limited chronic GVHD. See related commentary by Eckel and Deeg, p. 6404 . (©2020 American Association for Cancer Research.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu