Mild Acute Graft-Versus-Host Disease Improves Outcomes After HLA-Haploidentical-Related Donor Transplantation Using Posttransplant Cyclophosphamide and Cord Blood Transplantation

Autor: Fumiya Wada, Junya Kanda, Kimimori Kamijo, Masashi Nishikubo, Satoshi Yoshioka, Takayuki Ishikawa, Yasunori Ueda, Takashi Akasaka, Yasuyuki Arai, Kiyotaka Izumi, Hirokazu Hirata, Takashi Ikeda, Akihito Yonezawa, Naoyuki Anzai, Mitsumasa Watanabe, Kazunori Imada, Kazuhiro Yago, Naoki Tamura, Mitsuru Itoh, Yuki Masuo, Akane Kunitomi, Tomoharu Takeoka, Toshiyuki Kitano, Nobuyoshi Arima, Masakatsu Hishizawa, Kohsuke Asagoe, Tadakazu Kondo, Akifumi Takaori-Kondo
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Cell Transplantation, Vol 32 (2023)
Druh dokumentu: article
ISSN: 1555-3892
09636897
60873426
DOI: 10.1177/09636897231194497
Popis: Haploidentical-related donor transplantation using posttransplant cyclophosphamide (PTCy-haplo) and cord blood transplantation (CBT) are valid alternatives for patients with hematological malignancies when HLA-matched donor transplantation (MDT) is unavailable. However, the effects of graft-versus-host disease (GVHD) on outcomes after these transplants have not been fully elucidated. Therefore, we evaluated the effects of acute and chronic GVHD on transplant outcomes after PTCy-haplo transplants and compared them with CBT and MDT. We included a total of 914 adult patients with hematological malignancies in the Kyoto Stem Cell Transplantation Group registry who received PTCy-haplo (N = 120), CBT (N = 402), and MDT (N = 392), and achieved neutrophil engraftment. A multivariate analysis revealed that grade I–II acute GVHD improved of overall survival (OS) after PTCy-haplo [hazard ratio (HR) = 0.39, P = 0.018] and CBT (HR = 0.48, P < 0.001), but not after MDT (HR = 0.80, P = 0.267) compared with patients without acute GVHD. Grade I–II acute GVHD had a trend toward reducing the risk of nonrelapse mortality (NRM) after PTCy-haplo (HR = 0.13, P = 0.060) and this positive effect was significant after CBT (HR = 0.39, P = 0.003). A negative impact of grade III–IV acute GVHD on NRM was observed after CBT and MDT, but not after PTCy-haplo. Limited chronic GVHD had a positive impact on OS after CBT and MDT, but not after PTCy-haplo. In conclusion, mild acute GVHD improved outcomes after PTCy-haplo and CBT, and limited chronic GVHD improved outcomes after CBT and MDT. These data indicated that the effects of GVHD on transplant outcomes depended on transplant platforms.
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