Impact of graft-versus-host disease on allogeneic hematopoietic cell transplantation for adult T cell leukemia-lymphoma focusing on preconditioning regimens: nationwide retrospective study.

Abstract

Allogeneic hematopoietic cell transplantation (HCT), but not autologous HCT, can provide long-term remission in some patients with adult T cell leukemia-lymphoma (ATL). We retrospectively analyzed the effects of acute graft-versus-host disease (GVHD) among the 616 patients with ATL who survived at least 30 days after allogeneic HCT with other than cord blood grafts. Multivariate analyses treating the occurrence of GVHD as a time-varying covariate demonstrated an association between grade I-II acute GVHD and favorable overall survival (OS) (hazard ratio [HR], 0.634; 95% confidence interval [CI], 0.477 to 0.843), whereas grade III-IV acute GVHD showed a trend toward unfavorable OS (HR, 1.380; 95% CI, 0.988 to 1.927) compared with nonacute GVHD. In subsequent multivariate analyses of patients who survived at least 100 days after HCT (n = 431), the presence of limited chronic GVHD showed a trend toward favorable OS (HR, 0.597; 95% CI, 0.354 to 1.007), and extensive chronic GVHD had a significant effect on OS (HR, 0.585; 95% CI, 0.389 to 0.880). There were no significant interactions between myeloablative conditioning or reduced-intensity conditioning with OS even when acute GVHD was absent or present at grade I-II or grade III-IV or when chronic GVHD was absent, limited, or extensive. This study demonstrates the actual existence of graft-versus-ATL effects in patients with ATL regardless of whether myeloablative conditioning or reduced-intensity conditioning is used.

• Authors: Takashi Ishida, Masakatsu Hishizawa, Koji Kato, Ryuji Tanosaki, Takahiro Fukuda, Yoshifusa Takatsuka, Tetsuya Eto, Yasushi Miyazaki, Michihiro Hidaka, Naokuni Uike, Toshihiro Miyamoto, Mitsuru Tsudo, Hisashi Sakamaki, Yasuo Morishima, Ritsuro Suzuki, Atae Utsunomiya
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 19 Issue 12 Pg. 1731-9 (Dec 2013) ISSN: 1523-6536 [Electronic] United States
• PMID: 24090597 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Topics

• Acute Disease
• Cohort Studies
• Female
• Graft vs Host Disease (etiology, immunology)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Leukemia-Lymphoma, Adult T-Cell (immunology, surgery)
• Male
• Middle Aged
• Retrospective Studies
• Survival Analysis
• Transplantation Conditioning (adverse effects, methods)
• Transplantation, Autologous