Impact of chronic graft-versus-host disease on late relapse and survival on 7489 patients after myeloablative allogeneic hematopoietic cell transplantation for leukemia
Identifieur interne : 001916 ( Pmc/Corpus ); précédent : 001915; suivant : 001917Impact of chronic graft-versus-host disease on late relapse and survival on 7489 patients after myeloablative allogeneic hematopoietic cell transplantation for leukemia
Auteurs : Michael Boyiadzis ; Mukta Arora ; John P. Klein ; Anna Hassebroek ; Michael Hemmer ; Alvaro Urbano-Ispizua ; Joseph H. Antin ; Brian J. Bolwell ; Jean-Yves Y. Cahn ; Mitchell S. Cairo ; Corey S. Cutler ; Mary E. Flowers ; Robert P. Gale ; Roger Herzig ; Luis M. Isola ; David A. Jacobsohn ; Madan H. Jagasia ; Thomas R. Klumpp ; Stephanie J. Lee ; Effie W. Petersdorf ; Stella Santarone ; Stephen R. Spellman ; Harry C. Schouten ; Leo F. Verdonck ; John R. Wingard ; Daniel J. Weisdorf ; Mary M. Horowitz ; Steven Z. PavleticSource :
- Clinical cancer research : an official journal of the American Association for Cancer Research [ 1078-0432 ] ; 2014.
Abstract
Malignancy relapse remains a major obstacle for successful allogeneic hematopoietic cell transplantation (HCT). Chronic graft-versus-host disease (cGVHD) is associated with fewer relapses. However, when studying effects of cGVHD on relapse it is difficult to separate from acute GVHD effects as most cases of cGVHD occur within the first year post-transplant at the time when acute GVHD is still active.
The current study based on CIBMTR registry data investigated cGVHD and its association with the incidence of late relapse and survival in 7489 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and myelodysplastic syndromes (MDS) who were leukemia-free at12 months after myeloablative allogeneic HCT.
Forty-seven percent of the study population was diagnosed with cGVHD at 12 months after transplant. The protective effect of cGVHD on relapse was present only in patients with CML (RR: 0.47, 95% CI: 0.37-0.59, P <0.0001). cGVHD was significantly associated with higher risk of treatment related mortality, (RR: 2.43, 95% CI: 2.09-2.82, P <0.0001) and inferior overall survival (RR: 1.56, 95% CI: 1.41-1.73, P <0.0001) for all diseases. In patients with CML all organ sites and presentation types of cGVHD were equally associated with lower risk of late relapse.
These results indicate that clinically relevant anti-leukemia effects of cGVHD on late relapses are present only in CML but not in AML, ALL or MDS. Chronic GVHD in patients who are one year survivors after myeloablative allogeneic HCT is primarily associated with higher TRM and inferior survival.
Url:
DOI: 10.1158/1078-0432.CCR-14-0586
PubMed: 25348512
PubMed Central: 4411210
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Klein</name><affiliation><nlm:aff id="A3">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</nlm:aff></affiliation></author><author><name sortKey="Hassebroek, Anna" sort="Hassebroek, Anna" uniqKey="Hassebroek A" first="Anna" last="Hassebroek">Anna Hassebroek</name><affiliation><nlm:aff id="A4">Center for International Blood and Marrow Transplant Research, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Hemmer, Michael" sort="Hemmer, Michael" uniqKey="Hemmer M" first="Michael" last="Hemmer">Michael Hemmer</name><affiliation><nlm:aff id="A3">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</nlm:aff></affiliation></author><author><name sortKey="Urbano Ispizua, Alvaro" sort="Urbano Ispizua, Alvaro" uniqKey="Urbano Ispizua A" first="Alvaro" last="Urbano-Ispizua">Alvaro Urbano-Ispizua</name><affiliation><nlm:aff id="A5">Institute of Hematology and Oncology, Hospital Clínic.</nlm:aff></affiliation></author><author><name sortKey="Antin, Joseph H" sort="Antin, Joseph H" uniqKey="Antin J" first="Joseph H." last="Antin">Joseph H. Antin</name><affiliation><nlm:aff id="A6">Dana Farber Cancer Institute, Boston, MA USA</nlm:aff></affiliation></author><author><name sortKey="Bolwell, Brian J" sort="Bolwell, Brian J" uniqKey="Bolwell B" first="Brian J." last="Bolwell">Brian J. Bolwell</name><affiliation><nlm:aff id="A7">Cleveland Clinic Foundation, Cleveland, OH USA</nlm:aff></affiliation></author><author><name sortKey="Cahn, Jean Yves Y" sort="Cahn, Jean Yves Y" uniqKey="Cahn J" first="Jean-Yves Y." last="Cahn">Jean-Yves Y. Cahn</name><affiliation><nlm:aff id="A8">Hopital Michallon, CHU de Grenoble, Grenoble, France</nlm:aff></affiliation></author><author><name sortKey="Cairo, Mitchell S" sort="Cairo, Mitchell S" uniqKey="Cairo M" first="Mitchell S." last="Cairo">Mitchell S. Cairo</name><affiliation><nlm:aff id="A9">New York Medical College, Valhalla, NY</nlm:aff></affiliation></author><author><name sortKey="Cutler, Corey S" sort="Cutler, Corey S" uniqKey="Cutler C" first="Corey S." last="Cutler">Corey S. Cutler</name><affiliation><nlm:aff id="A6">Dana Farber Cancer Institute, Boston, MA USA</nlm:aff></affiliation></author><author><name sortKey="Flowers, Mary E" sort="Flowers, Mary E" uniqKey="Flowers M" first="Mary E." last="Flowers">Mary E. Flowers</name><affiliation><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, WA USA</nlm:aff></affiliation></author><author><name sortKey="Gale, Robert P" sort="Gale, Robert P" uniqKey="Gale R" first="Robert P." last="Gale">Robert P. Gale</name><affiliation><nlm:aff id="A11">Imperial College, London, UK</nlm:aff></affiliation></author><author><name sortKey="Herzig, Roger" sort="Herzig, Roger" uniqKey="Herzig R" first="Roger" last="Herzig">Roger Herzig</name><affiliation><nlm:aff id="A12">University of Louisville, Hospital/James Brown Cancer Center, Louisville, KY USA</nlm:aff></affiliation></author><author><name sortKey="Isola, Luis M" sort="Isola, Luis M" uniqKey="Isola L" first="Luis M." last="Isola">Luis M. Isola</name><affiliation><nlm:aff id="A13">Mount Sinai Medical Center, Miami, FL USA</nlm:aff></affiliation></author><author><name sortKey="Jacobsohn, David A" sort="Jacobsohn, David A" uniqKey="Jacobsohn D" first="David A." last="Jacobsohn">David A. Jacobsohn</name><affiliation><nlm:aff id="A14">National Medical Center, Washington, DC USA</nlm:aff></affiliation></author><author><name sortKey="Jagasia, Madan H" sort="Jagasia, Madan H" uniqKey="Jagasia M" first="Madan H." last="Jagasia">Madan H. Jagasia</name><affiliation><nlm:aff id="A15">Vanderbilt University Medical Center; Nashville, TN USA</nlm:aff></affiliation></author><author><name sortKey="Klumpp, Thomas R" sort="Klumpp, Thomas R" uniqKey="Klumpp T" first="Thomas R." last="Klumpp">Thomas R. Klumpp</name><affiliation><nlm:aff id="A16">Temple Bone Marrow Transplant Program, Philadelphia, PA USA</nlm:aff></affiliation></author><author><name sortKey="Lee, Stephanie J" sort="Lee, Stephanie J" uniqKey="Lee S" first="Stephanie J." last="Lee">Stephanie J. Lee</name><affiliation><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, WA USA</nlm:aff></affiliation></author><author><name sortKey="Petersdorf, Effie W" sort="Petersdorf, Effie W" uniqKey="Petersdorf E" first="Effie W." last="Petersdorf">Effie W. Petersdorf</name><affiliation><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, WA USA</nlm:aff></affiliation></author><author><name sortKey="Santarone, Stella" sort="Santarone, Stella" uniqKey="Santarone S" first="Stella" last="Santarone">Stella Santarone</name><affiliation><nlm:aff id="A17">Ospedale Civile BMT Center, Pescara, Italy</nlm:aff></affiliation></author><author><name sortKey="Spellman, Stephen R" sort="Spellman, Stephen R" uniqKey="Spellman S" first="Stephen R." last="Spellman">Stephen R. Spellman</name><affiliation><nlm:aff id="A4">Center for International Blood and Marrow Transplant Research, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Schouten, Harry C" sort="Schouten, Harry C" uniqKey="Schouten H" first="Harry C." last="Schouten">Harry C. Schouten</name><affiliation><nlm:aff id="A18">Academische Ziekenhuis Maastricht, Maastricht, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Verdonck, Leo F" sort="Verdonck, Leo F" uniqKey="Verdonck L" first="Leo F." last="Verdonck">Leo F. Verdonck</name><affiliation><nlm:aff id="A19">Isala Clinics, Zwolle, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Wingard, John R" sort="Wingard, John R" uniqKey="Wingard J" first="John R." last="Wingard">John R. Wingard</name><affiliation><nlm:aff id="A20">Shands HealthCare & University of Florida, Gainesville, FL, USA</nlm:aff></affiliation></author><author><name sortKey="Weisdorf, Daniel J" sort="Weisdorf, Daniel J" uniqKey="Weisdorf D" first="Daniel J." last="Weisdorf">Daniel J. Weisdorf</name><affiliation><nlm:aff id="A2">University of Minnesota Medical Center, Fairview, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Horowitz, Mary M" sort="Horowitz, Mary M" uniqKey="Horowitz M" first="Mary M." last="Horowitz">Mary M. Horowitz</name><affiliation><nlm:aff id="A3">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</nlm:aff></affiliation></author><author><name sortKey="Pavletic, Steven Z" sort="Pavletic, Steven Z" uniqKey="Pavletic S" first="Steven Z." last="Pavletic">Steven Z. Pavletic</name><affiliation><nlm:aff id="A21">National Cancer Institute, Bethesda, MD</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25348512</idno><idno type="pmc">4411210</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411210</idno><idno type="RBID">PMC:4411210</idno><idno type="doi">10.1158/1078-0432.CCR-14-0586</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001916</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001916</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Impact of chronic graft-versus-host disease on late relapse and survival on 7489 patients after myeloablative allogeneic hematopoietic cell transplantation for leukemia</title><author><name sortKey="Boyiadzis, Michael" sort="Boyiadzis, Michael" uniqKey="Boyiadzis M" first="Michael" last="Boyiadzis">Michael Boyiadzis</name><affiliation><nlm:aff id="A1">University of Pittsburgh School of Medicine, Pittsburgh, PA USA</nlm:aff></affiliation></author><author><name sortKey="Arora, Mukta" sort="Arora, Mukta" uniqKey="Arora M" first="Mukta" last="Arora">Mukta Arora</name><affiliation><nlm:aff id="A2">University of Minnesota Medical Center, Fairview, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Klein, John P" sort="Klein, John P" uniqKey="Klein J" first="John P." last="Klein">John P. Klein</name><affiliation><nlm:aff id="A3">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</nlm:aff></affiliation></author><author><name sortKey="Hassebroek, Anna" sort="Hassebroek, Anna" uniqKey="Hassebroek A" first="Anna" last="Hassebroek">Anna Hassebroek</name><affiliation><nlm:aff id="A4">Center for International Blood and Marrow Transplant Research, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Hemmer, Michael" sort="Hemmer, Michael" uniqKey="Hemmer M" first="Michael" last="Hemmer">Michael Hemmer</name><affiliation><nlm:aff id="A3">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</nlm:aff></affiliation></author><author><name sortKey="Urbano Ispizua, Alvaro" sort="Urbano Ispizua, Alvaro" uniqKey="Urbano Ispizua A" first="Alvaro" last="Urbano-Ispizua">Alvaro Urbano-Ispizua</name><affiliation><nlm:aff id="A5">Institute of Hematology and Oncology, Hospital Clínic.</nlm:aff></affiliation></author><author><name sortKey="Antin, Joseph H" sort="Antin, Joseph H" uniqKey="Antin J" first="Joseph H." last="Antin">Joseph H. Antin</name><affiliation><nlm:aff id="A6">Dana Farber Cancer Institute, Boston, MA USA</nlm:aff></affiliation></author><author><name sortKey="Bolwell, Brian J" sort="Bolwell, Brian J" uniqKey="Bolwell B" first="Brian J." last="Bolwell">Brian J. Bolwell</name><affiliation><nlm:aff id="A7">Cleveland Clinic Foundation, Cleveland, OH USA</nlm:aff></affiliation></author><author><name sortKey="Cahn, Jean Yves Y" sort="Cahn, Jean Yves Y" uniqKey="Cahn J" first="Jean-Yves Y." last="Cahn">Jean-Yves Y. Cahn</name><affiliation><nlm:aff id="A8">Hopital Michallon, CHU de Grenoble, Grenoble, France</nlm:aff></affiliation></author><author><name sortKey="Cairo, Mitchell S" sort="Cairo, Mitchell S" uniqKey="Cairo M" first="Mitchell S." last="Cairo">Mitchell S. Cairo</name><affiliation><nlm:aff id="A9">New York Medical College, Valhalla, NY</nlm:aff></affiliation></author><author><name sortKey="Cutler, Corey S" sort="Cutler, Corey S" uniqKey="Cutler C" first="Corey S." last="Cutler">Corey S. Cutler</name><affiliation><nlm:aff id="A6">Dana Farber Cancer Institute, Boston, MA USA</nlm:aff></affiliation></author><author><name sortKey="Flowers, Mary E" sort="Flowers, Mary E" uniqKey="Flowers M" first="Mary E." last="Flowers">Mary E. Flowers</name><affiliation><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, WA USA</nlm:aff></affiliation></author><author><name sortKey="Gale, Robert P" sort="Gale, Robert P" uniqKey="Gale R" first="Robert P." last="Gale">Robert P. Gale</name><affiliation><nlm:aff id="A11">Imperial College, London, UK</nlm:aff></affiliation></author><author><name sortKey="Herzig, Roger" sort="Herzig, Roger" uniqKey="Herzig R" first="Roger" last="Herzig">Roger Herzig</name><affiliation><nlm:aff id="A12">University of Louisville, Hospital/James Brown Cancer Center, Louisville, KY USA</nlm:aff></affiliation></author><author><name sortKey="Isola, Luis M" sort="Isola, Luis M" uniqKey="Isola L" first="Luis M." last="Isola">Luis M. Isola</name><affiliation><nlm:aff id="A13">Mount Sinai Medical Center, Miami, FL USA</nlm:aff></affiliation></author><author><name sortKey="Jacobsohn, David A" sort="Jacobsohn, David A" uniqKey="Jacobsohn D" first="David A." last="Jacobsohn">David A. Jacobsohn</name><affiliation><nlm:aff id="A14">National Medical Center, Washington, DC USA</nlm:aff></affiliation></author><author><name sortKey="Jagasia, Madan H" sort="Jagasia, Madan H" uniqKey="Jagasia M" first="Madan H." last="Jagasia">Madan H. Jagasia</name><affiliation><nlm:aff id="A15">Vanderbilt University Medical Center; Nashville, TN USA</nlm:aff></affiliation></author><author><name sortKey="Klumpp, Thomas R" sort="Klumpp, Thomas R" uniqKey="Klumpp T" first="Thomas R." last="Klumpp">Thomas R. Klumpp</name><affiliation><nlm:aff id="A16">Temple Bone Marrow Transplant Program, Philadelphia, PA USA</nlm:aff></affiliation></author><author><name sortKey="Lee, Stephanie J" sort="Lee, Stephanie J" uniqKey="Lee S" first="Stephanie J." last="Lee">Stephanie J. Lee</name><affiliation><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, WA USA</nlm:aff></affiliation></author><author><name sortKey="Petersdorf, Effie W" sort="Petersdorf, Effie W" uniqKey="Petersdorf E" first="Effie W." last="Petersdorf">Effie W. Petersdorf</name><affiliation><nlm:aff id="A10">Fred Hutchinson Cancer Research Center, Seattle, WA USA</nlm:aff></affiliation></author><author><name sortKey="Santarone, Stella" sort="Santarone, Stella" uniqKey="Santarone S" first="Stella" last="Santarone">Stella Santarone</name><affiliation><nlm:aff id="A17">Ospedale Civile BMT Center, Pescara, Italy</nlm:aff></affiliation></author><author><name sortKey="Spellman, Stephen R" sort="Spellman, Stephen R" uniqKey="Spellman S" first="Stephen R." last="Spellman">Stephen R. Spellman</name><affiliation><nlm:aff id="A4">Center for International Blood and Marrow Transplant Research, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Schouten, Harry C" sort="Schouten, Harry C" uniqKey="Schouten H" first="Harry C." last="Schouten">Harry C. Schouten</name><affiliation><nlm:aff id="A18">Academische Ziekenhuis Maastricht, Maastricht, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Verdonck, Leo F" sort="Verdonck, Leo F" uniqKey="Verdonck L" first="Leo F." last="Verdonck">Leo F. Verdonck</name><affiliation><nlm:aff id="A19">Isala Clinics, Zwolle, Netherlands</nlm:aff></affiliation></author><author><name sortKey="Wingard, John R" sort="Wingard, John R" uniqKey="Wingard J" first="John R." last="Wingard">John R. Wingard</name><affiliation><nlm:aff id="A20">Shands HealthCare & University of Florida, Gainesville, FL, USA</nlm:aff></affiliation></author><author><name sortKey="Weisdorf, Daniel J" sort="Weisdorf, Daniel J" uniqKey="Weisdorf D" first="Daniel J." last="Weisdorf">Daniel J. Weisdorf</name><affiliation><nlm:aff id="A2">University of Minnesota Medical Center, Fairview, Minneapolis, MN USA</nlm:aff></affiliation></author><author><name sortKey="Horowitz, Mary M" sort="Horowitz, Mary M" uniqKey="Horowitz M" first="Mary M." last="Horowitz">Mary M. Horowitz</name><affiliation><nlm:aff id="A3">Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</nlm:aff></affiliation></author><author><name sortKey="Pavletic, Steven Z" sort="Pavletic, Steven Z" uniqKey="Pavletic S" first="Steven Z." last="Pavletic">Steven Z. Pavletic</name><affiliation><nlm:aff id="A21">National Cancer Institute, Bethesda, MD</nlm:aff></affiliation></author></analytic><series><title level="j">Clinical cancer research : an official journal of the American Association for Cancer Research</title><idno type="ISSN">1078-0432</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Purpose</title><p id="P1">Malignancy relapse remains a major obstacle for successful allogeneic hematopoietic cell transplantation (HCT). Chronic graft-versus-host disease (cGVHD) is associated with fewer relapses. However, when studying effects of cGVHD on relapse it is difficult to separate from acute GVHD effects as most cases of cGVHD occur within the first year post-transplant at the time when acute GVHD is still active.</p></sec><sec id="S2"><title>Experimental design</title><p id="P2">The current study based on CIBMTR registry data investigated cGVHD and its association with the incidence of late relapse and survival in 7489 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and myelodysplastic syndromes (MDS) who were leukemia-free at12 months after myeloablative allogeneic HCT.</p></sec><sec id="S3"><title>Results</title><p id="P3">Forty-seven percent of the study population was diagnosed with cGVHD at 12 months after transplant. The protective effect of cGVHD on relapse was present only in patients with CML (RR: 0.47, 95% CI: 0.37-0.59, P <0.0001). cGVHD was significantly associated with higher risk of treatment related mortality, (RR: 2.43, 95% CI: 2.09-2.82, P <0.0001) and inferior overall survival (RR: 1.56, 95% CI: 1.41-1.73, P <0.0001) for all diseases. In patients with CML all organ sites and presentation types of cGVHD were equally associated with lower risk of late relapse.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">These results indicate that clinically relevant anti-leukemia effects of cGVHD on late relapses are present only in CML but not in AML, ALL or MDS. Chronic GVHD in patients who are one year survivors after myeloablative allogeneic HCT is primarily associated with higher TRM and inferior survival.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
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Cancer Res.</journal-id><journal-title-group><journal-title>Clinical cancer research : an official journal of the American Association for Cancer Research</journal-title></journal-title-group><issn pub-type="ppub">1078-0432</issn></journal-meta><article-meta><article-id pub-id-type="pmid">25348512</article-id><article-id pub-id-type="pmc">4411210</article-id><article-id pub-id-type="doi">10.1158/1078-0432.CCR-14-0586</article-id><article-id pub-id-type="manuscript">NIHMS638601</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Impact of chronic graft-versus-host disease on late relapse and survival on 7489 patients after myeloablative allogeneic hematopoietic cell transplantation for leukemia</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Boyiadzis</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Arora</surname><given-names>Mukta</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Klein</surname><given-names>John P.</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Hassebroek</surname><given-names>Anna</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Hemmer</surname><given-names>Michael</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Urbano-Ispizua</surname><given-names>Alvaro</given-names></name><xref ref-type="aff" rid="A5">5</xref></contrib><contrib contrib-type="author"><name><surname>Antin</surname><given-names>Joseph H.</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Bolwell</surname><given-names>Brian J.</given-names></name><xref ref-type="aff" rid="A7">7</xref></contrib><contrib contrib-type="author"><name><surname>Cahn</surname><given-names>Jean-Yves Y.</given-names></name><xref ref-type="aff" rid="A8">8</xref></contrib><contrib contrib-type="author"><name><surname>Cairo</surname><given-names>Mitchell S.</given-names></name><xref ref-type="aff" rid="A9">9</xref></contrib><contrib contrib-type="author"><name><surname>Cutler</surname><given-names>Corey S.</given-names></name><xref ref-type="aff" rid="A6">6</xref></contrib><contrib contrib-type="author"><name><surname>Flowers</surname><given-names>Mary E.</given-names></name><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Gale</surname><given-names>Robert P.</given-names></name><xref ref-type="aff" rid="A11">11</xref></contrib><contrib contrib-type="author"><name><surname>Herzig</surname><given-names>Roger</given-names></name><xref ref-type="aff" rid="A12">12</xref></contrib><contrib contrib-type="author"><name><surname>Isola</surname><given-names>Luis M.</given-names></name><xref ref-type="aff" rid="A13">13</xref></contrib><contrib contrib-type="author"><name><surname>Jacobsohn</surname><given-names>David A.</given-names></name><xref ref-type="aff" rid="A14">14</xref></contrib><contrib contrib-type="author"><name><surname>Jagasia</surname><given-names>Madan H.</given-names></name><xref ref-type="aff" rid="A15">15</xref></contrib><contrib contrib-type="author"><name><surname>Klumpp</surname><given-names>Thomas R.</given-names></name><xref ref-type="aff" rid="A16">16</xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Stephanie J.</given-names></name><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Petersdorf</surname><given-names>Effie W.</given-names></name><xref ref-type="aff" rid="A10">10</xref></contrib><contrib contrib-type="author"><name><surname>Santarone</surname><given-names>Stella</given-names></name><xref ref-type="aff" rid="A17">17</xref></contrib><contrib contrib-type="author"><name><surname>Spellman</surname><given-names>Stephen R.</given-names></name><xref ref-type="aff" rid="A4">4</xref></contrib><contrib contrib-type="author"><name><surname>Schouten</surname><given-names>Harry C.</given-names></name><xref ref-type="aff" rid="A18">18</xref></contrib><contrib contrib-type="author"><name><surname>Verdonck</surname><given-names>Leo F.</given-names></name><xref ref-type="aff" rid="A19">19</xref></contrib><contrib contrib-type="author"><name><surname>Wingard</surname><given-names>John R.</given-names></name><xref ref-type="aff" rid="A20">20</xref></contrib><contrib contrib-type="author"><name><surname>Weisdorf</surname><given-names>Daniel J.</given-names></name><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Horowitz</surname><given-names>Mary M.</given-names></name><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Pavletic</surname><given-names>Steven Z.</given-names></name><xref ref-type="aff" rid="A21">21</xref></contrib></contrib-group><aff id="A1"><label>1</label>University of Pittsburgh School of Medicine, Pittsburgh, PA USA</aff><aff id="A2"><label>2</label>University of Minnesota Medical Center, Fairview, Minneapolis, MN USA</aff><aff id="A3"><label>3</label>Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI USA</aff><aff id="A4"><label>4</label>Center for International Blood and Marrow Transplant Research, Minneapolis, MN USA</aff><aff id="A5"><label>5</label>Institute of Hematology and Oncology, Hospital Clínic.</aff><aff id="A6"><label>6</label>Dana Farber Cancer Institute, Boston, MA USA</aff><aff id="A7"><label>7</label>Cleveland Clinic Foundation, Cleveland, OH USA</aff><aff id="A8"><label>8</label>Hopital Michallon, CHU de Grenoble, Grenoble, France</aff><aff id="A9"><label>9</label>New York Medical College, Valhalla, NY</aff><aff id="A10"><label>10</label>Fred Hutchinson Cancer Research Center, Seattle, WA USA</aff><aff id="A11"><label>11</label>Imperial College, London, UK</aff><aff id="A12"><label>12</label>University of Louisville, Hospital/James Brown Cancer Center, Louisville, KY USA</aff><aff id="A13"><label>13</label>Mount Sinai Medical Center, Miami, FL USA</aff><aff id="A14"><label>14</label>National Medical Center, Washington, DC USA</aff><aff id="A15"><label>15</label>Vanderbilt University Medical Center; Nashville, TN USA</aff><aff id="A16"><label>16</label>Temple Bone Marrow Transplant Program, Philadelphia, PA USA</aff><aff id="A17"><label>17</label>Ospedale Civile BMT Center, Pescara, Italy</aff><aff id="A18"><label>18</label>Academische Ziekenhuis Maastricht, Maastricht, Netherlands</aff><aff id="A19"><label>19</label>Isala Clinics, Zwolle, Netherlands</aff><aff id="A20"><label>20</label>Shands HealthCare & University of Florida, Gainesville, FL, USA</aff><aff id="A21"><label>21</label>National Cancer Institute, Bethesda, MD</aff><author-notes><corresp id="CR1"><bold>Corresponding Author:</bold> Michael Boyiadzis, MD, MHSc. University of Pittsburgh Cancer Institute, UPMC Cancer Pavilion, 5150 Centre Avenue, Suite 572,Pittsburgh, PA 15232. Phone: 412-648-6589, Fax:412-648-6579, <email>boyiadzism@upmc.edu</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>9</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>27</day><month>10</month><year>2014</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>5</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>5</month><year>2016</year></pub-date><volume>21</volume><issue>9</issue><fpage>2020</fpage><lpage>2028</lpage><pmc-comment>elocation-id from pubmed: 10.1158/1078-0432.CCR-14-0586</pmc-comment>
<abstract><sec id="S1"><title>Purpose</title><p id="P1">Malignancy relapse remains a major obstacle for successful allogeneic hematopoietic cell transplantation (HCT). Chronic graft-versus-host disease (cGVHD) is associated with fewer relapses. However, when studying effects of cGVHD on relapse it is difficult to separate from acute GVHD effects as most cases of cGVHD occur within the first year post-transplant at the time when acute GVHD is still active.</p></sec><sec id="S2"><title>Experimental design</title><p id="P2">The current study based on CIBMTR registry data investigated cGVHD and its association with the incidence of late relapse and survival in 7489 patients with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML) and myelodysplastic syndromes (MDS) who were leukemia-free at12 months after myeloablative allogeneic HCT.</p></sec><sec id="S3"><title>Results</title><p id="P3">Forty-seven percent of the study population was diagnosed with cGVHD at 12 months after transplant. The protective effect of cGVHD on relapse was present only in patients with CML (RR: 0.47, 95% CI: 0.37-0.59, P <0.0001). cGVHD was significantly associated with higher risk of treatment related mortality, (RR: 2.43, 95% CI: 2.09-2.82, P <0.0001) and inferior overall survival (RR: 1.56, 95% CI: 1.41-1.73, P <0.0001) for all diseases. In patients with CML all organ sites and presentation types of cGVHD were equally associated with lower risk of late relapse.</p></sec><sec id="S4"><title>Conclusions</title><p id="P4">These results indicate that clinically relevant anti-leukemia effects of cGVHD on late relapses are present only in CML but not in AML, ALL or MDS. Chronic GVHD in patients who are one year survivors after myeloablative allogeneic HCT is primarily associated with higher TRM and inferior survival.</p></sec></abstract><kwd-group><kwd>allogeneic hematopoietic cell transplantation</kwd><kwd>chronic graft-versus-host disease</kwd><kwd>relapse</kwd><kwd>leukemia</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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