Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma
| Autor: | H. Schouten, Mei-Jie Zhang, Vikas Gupta, Sagar Lonial, Smriti Shrestha, G. T. Da Silva, Kenneth R. Meehan, Giuseppe Milone, O Ringden, Mats Remberger, P.L. McCarthy, Robert Peter Gale, John Gibson, Angela Dispenzieri, Rammurti T. Kamble, C. O. Freytes, Parameswaran Hari, Hillard M. Lazarus, Leona Holmberg |
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| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Allogeneic transplantation medicine.medical_treatment Hematopoietic stem cell transplantation Gastroenterology 03 medical and health sciences 0302 clinical medicine immune system diseases hemic and lymphatic diseases Internal medicine Medicine Survival rate Multiple myeloma Transplantation business.industry Proportional hazards model Hematology medicine.disease 3. Good health surgical procedures operative Graft-versus-host disease 030220 oncology & carcinogenesis Immunology Transplantation Conditioning business 030215 immunology |
| Zdroj: | Bone Marrow Transplantation. 47:831-837 |
| ISSN: | 1476-5365 0268-3369 |
| Popis: | We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42% (95% confidence interval (CI), 35-49%) and of chronic GVHD (cGVHD) at 5 years was 59% (95% CI, 49-69%), with 70% developing extensive cGVHD. In multivariate analysis, aGVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage. |
| Databáze: | OpenAIRE |
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