Predictors of hematologic malignancy relapse in patients with advanced chronic graft-versus-host disease
| Autor: | Lauren M. Curtis, Galen O. Joe, Judy Baruffaldi, Ana Zelic Kerep, Steven Z. Pavletic, Ann Berger, Laura Parsons-Wandell, Filip Pirsl, Noa G. Holtzman, Seth M. Steinberg, Claire L. Ruben, Manuel B. Datiles, Edward W. Cowen, Jacqueline W. Mays, Sandra A. Mitchell |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Graft vs Host Disease Hematopoietic stem cell transplantation Disease Malignancy Gastroenterology Article 03 medical and health sciences 0302 clinical medicine immune system diseases Internal medicine hemic and lymphatic diseases Medicine Humans In patient Prospective Studies Retrospective Studies Transplantation business.industry Hematopoietic Stem Cell Transplantation Cancer Hematology medicine.disease Graft-versus-host disease Cross-Sectional Studies 030220 oncology & carcinogenesis Hematologic Neoplasms Chronic Disease Neoplasm Recurrence Local business Body mass index Natural history study 030215 immunology |
| Zdroj: | Bone marrow transplantation |
| ISSN: | 1476-5365 |
| Popis: | Malignancy relapse remains a major barrier to treatment success in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Chronic graft-versus-host disease (cGVHD) markedly reduces hematologic malignancy relapse risk, but relapses still occur in these patients. Patients (n = 275) with moderate or severe cGVHD were enrolled on the National Cancer Institute (NCI) prospective cross-sectional natural history study (NCT00092235). Subjects were median 36 months after allo-HSCT and were followed subsequently for malignancy relapse and survival. Seventeen patients experienced relapse. In a multivariable model including time-dependent influences on relapse, risk factors associated with increased risk of relapse included shorter time from transplant to cGVHD evaluation (HR 0.279, 95% CI 0.078-0.995) and lower number of prior lines of systemic immunosuppressive therapy for cGVHD (HR 0.260, 95% CI 0.094-0.719). In a model excluding time-dependent influences on relapse risk, lower number of prior lines of systemic immunosuppressive therapy for cGVHD (HR 0.288, 95% CI 0.103-0.804), lower C4 complement level (HR 0.346, 95% CI 0.129-0.923), and higher body mass index (HR 3.222, 95% CI 1.156-8.974), were all associated with increased relapse risk. Parameters indicating cGVHD severity and activity are associated with risk of malignancy relapse. Classical predictors of relapse after allo-HSCT do not seem to be prognostic. |
| Databáze: | OpenAIRE |
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