Impact of graft-versus-host disease on outcomes after allogeneic hematopoietic cell transplantation for adult T-cell leukemia: a retrospective cohort study.

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is an effective treatment for adult T-cell leukemia (ATL), raising the question about the role of graft-versus-leukemia effect against ATL. In this study, we retrospectively analyzed the effects of acute and chronic graft-versus-host disease (GVHD) on overall survival, disease-associated mortality, and treatment-related mortality among 294 ATL patients who received allogeneic HCT and survived at least 30 days posttransplant with sustained engraftment. Multivariate analyses treating the occurrence of GVHD as a time-varying covariate demonstrated that the development of grade 1-2 acute GVHD was significantly associated with higher overall survival (hazard ratio [HR] for death, 0.65; P = .018) compared with the absence of acute GVHD. Occurrence of either grade 1-2 or grade 3-4 acute GVHD was associated with lower disease-associated mortality compared with the absence of acute GVHD, whereas grade 3-4 acute GVHD was associated with a higher risk for treatment-related mortality (HR, 3.50; P < .001). The development of extensive chronic GVHD was associated with higher treatment-related mortality (HR, 2.75; P = .006) compared with the absence of chronic GVHD. Collectively, these results indicate that the development of mild-to-moderate acute GVHD confers a lower risk of disease progression and a beneficial influence on survival of allografted patients with ATL.

• Authors: Junya Kanda, Masakatsu Hishizawa, Atae Utsunomiya, Shuichi Taniguchi, Tetsuya Eto, Yukiyoshi Moriuchi, Ryuji Tanosaki, Fumio Kawano, Yasushi Miyazaki, Masato Masuda, Koji Nagafuji, Masamichi Hara, Minoko Takanashi, Shunro Kai, Yoshiko Atsuta, Ritsuro Suzuki, Takakazu Kawase, Keitaro Matsuo, Tokiko Nagamura-Inoue, Shunichi Kato, Hisashi Sakamaki, Yasuo Morishima, Jun Okamura, Tatsuo Ichinohe, Takashi Uchiyama
• Journal: Blood (Blood) Vol. 119 Issue 9 Pg. 2141-8 (Mar 01 2012) ISSN: 1528-0020 [Electronic] United States
• PMID: 22234682 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Cohort Studies
• Female
• Graft vs Host Disease (complications)
• Hematopoietic Stem Cell Transplantation
• Humans
• Leukemia-Lymphoma, Adult T-Cell (complications, mortality, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Transplantation Conditioning
• Transplantation, Homologous
• Treatment Outcome
• Young Adult