1.Impact of graft versus host disease on outcome of allogeneic peripherial blood stem cell transplantation for leukemia.
Meizhang LI ; Weiping ZHANG ; Jianmin WANG ; Xianmin SONG ; Jianmin YANG ; Xiong NI ; Dan YANG ; Li CHEN ; Jie CHEN ; Xiaoxia HU ; Lei GAO ; Huiying QIU ; Hong ZHOU ; Hui CHENG
Chinese Journal of Hematology 2014;35(5):428-433
OBJECTIVETo analyze the impact of the occurrence and severity of acute and chronic graft versus host disease (GVHD) on the long-term outcome of allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for leukemia.
METHODSA total of 231 patients with leukemia, who underwent allo-HSCT in Changhai Hospital from Jan 1st, 2001 to Dec 31th, 2011, were retrospectively analyzed. The overall survival (OS), disease-free survival (DFS), transplantation-related mortality (TRM) and relapse rate (RR) were estimated according to the degree of acute and chronic GVHD.
RESULTS(1) Among the 224 assessable patients, aGVHD was observed in 85 patients, in which 46 developed grade I, 25 grade II and 14 grade III-IV. A total of 213 patients who survived beyond 100 days, cGVHD was observed in 109 patients, in which 84 developed limited cGVHD and 25 extensive cGVHD. (2)The incidence of 3-year OS and EFS of patients with aGVHD grade 0-I was significantly higher than that of grade II-IV (69.5% vs 33.6%, P<0.01; 60.7% vs 33.7%, P<0.01). The 3-year TRM of patients with 0-I grade aGVHD was significantly lower than that of the grade II-IV group (15.0% vs 56.7%, P<0.01). (3)The 5-year OS of patients with limited cGVHD was higher than patients without or with extensive cGVHD (79.8% vs 55.6% and 56.4%, P<0.01 and P=0.038, respectively). The 5-year TRM in patients with extensive cGVHD was higher than patients with limited cGVHD (14.1% vs 41.1%, P=0.018). However, the 5-year RR in patients without cGVHD was higher than patients with limited cGVHD or extensive cGVHD (47.2% vs 10.9% and 12.4%, P<0.01 and P=0.007, respectively). (4) The COX analysis showed that unrelated donor and myeloablative conditioning regimen were main factors affecting aGVHD; Meanwhile, aGVHD was the only factor affecting the cGVHD.
CONCLUSIONOur results showed that the patients with acute GVHD tended to have poor outcomes, especially with grade III-IV. On the contrary, the patients with limited cGVHD had lower RR and a long-term DFS.
Disease-Free Survival ; Graft vs Host Disease ; Humans ; Leukemia ; therapy ; Peripheral Blood Stem Cell Transplantation ; Retrospective Studies ; Transplantation Conditioning ; Transplantation, Homologous ; Treatment Outcome ; Unrelated Donors
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