Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study.

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a therapeutic option that may lead to improved outcomes in patients with chronic myelomonocytic leukemia (CMML). However, few studies have examined the impact of the grade of graft-versus-host disease (GVHD) on post-transplant outcomes for CMML. We retrospectively analyzed the outcomes of 141 patients with CMML who underwent allo-HSCT between 1987 and 2010, and achieved neutrophil engraftment. The effects of acute GVHD (aGVHD) or chronic GVHD (cGVHD) on overall survival (OS), leukemia-associated mortality (LAM), and transplant-related mortality were evaluated by hazards regression models, in which the onset date of aGVHD or cGVHD was treated as a time-dependent covariate. Grade I aGVHD was associated with better OS and lower LAM (P=0.042, P=0.033, respectively) than no GVHD in univariate analyses, but not in the multivariate analyses. The multivariate analyses demonstrated that extensive cGVHD significantly associated with better OS (Hazard Ratio [HR] 0.35 [95% confidence intervals (CI), 0.16-0.74]; P=0.007) and lower LAM (HR 0.36 [95% CI, 0.14-0.92]; P=0.033) in patients who were not in complete remission at transplantation. In conclusion, the occurrence of cGVHD may be an important factor affecting the outcomes of CMML patients who received transplantation.

• Authors: Hidehiro Itonaga, Masako Iwanaga, Kazunari Aoki, Jun Aoki, Ken Ishiyama, Takayuki Ishikawa, Toru Sakura, Takahiro Fukuda, Yuho Najima, Toshiaki Yujiri, Takehiko Mori, Mineo Kurokawa, Yuichiro Nawa, Naoyuki Uchida, Yoshihisa Morishita, Hisako Hashimoto, Tetsuya Eto, Makoto Hirokawa, Yasuo Morishima, Tokiko Nagamura-Inoue, Yoshiko Atsuta, Yasushi Miyazaki
• Journal: Leukemia research (Leuk Res) Vol. 41 Pg. 48-55 (Feb 2016) ISSN: 1873-5835 [Electronic] England
• PMID: 26754557 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2015 Elsevier Ltd. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Female
• Graft vs Host Disease
• Graft vs Leukemia Effect
• Hematopoietic Stem Cell Transplantation
• Humans
• Kaplan-Meier Estimate
• Leukemia, Myelomonocytic, Chronic (mortality, surgery)
• Male
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Transplantation, Homologous
• Young Adult