TY - JOUR
T1 - Clinical Benefit of Response in Chronic Graft-versus-Host Disease
AU - Inamoto, Yoshihiro
AU - Martin, Paul J.
AU - Chai, Xiaoyu
AU - Jagasia, Madan
AU - Palmer, Jeanne
AU - Pidala, Joseph
AU - Cutler, Corey
AU - Pavletic, Steven Z.
AU - Arora, Mukta
AU - Jacobsohn, David
AU - Carpenter, Paul A.
AU - Flowers, Mary E.D.
AU - Khera, Nandita
AU - Vogelsang, Georgia B.
AU - Weisdorf, Daniel
AU - Storer, Barry E.
AU - Lee, Stephanie J.
N1 - Funding Information:
Financial disclosure: This work was supported by National Institutes of Health grants CA118953 and CA163438 . Y.I. is a recipient of a Japan Society for the Promotion of Science Postdoctoral Fellowship for Research Abroad. The authors have no conflicts of interest to disclose.
PY - 2012/10
Y1 - 2012/10
N2 - To determine whether changes in objective response measures proposed by the National Institutes of Health correlate with clinical benefit, such as symptom burden, quality of life, and survival outcomes, we analyzed data from a multicenter prospective cohort of 283 patients with chronic graft-versus-host disease requiring systemic treatment. The median follow-up time of survivors was 25.1 months (range, 5.4-47.7 months) after enrollment. Symptom measures included the Lee symptom scale and 10-point patient-reported symptoms. Quality-of-life measures included the Short Form-36, Functional Assessment of Cancer Therapy-Bone Marrow Transplantation, and Human Activities Profile. Overall and organ-specific responses were calculated by comparing manifestations at the 6-month visit and those at the enrollment visit using a provisional algorithm. Complete or partial responses were considered "response," and stable or progressive disease was considered "no response." Overall response rate at 6 months was 32%. Organ-specific response rates were 45% for skin, 23% for eyes, 32% for mouth, and 51% for gastrointestinal tract. Response at 6 months, as calculated according to the provisional response algorithm, was correlated with changes in symptom burden in patients with newly diagnosed chronic graft-versus-host disease, but not with changes in quality of life or survival outcomes. Modification of the algorithm or validation of other more meaningful clinical endpoints is warranted for future clinical trials of treatment for chronic graft-versus-host disease.
AB - To determine whether changes in objective response measures proposed by the National Institutes of Health correlate with clinical benefit, such as symptom burden, quality of life, and survival outcomes, we analyzed data from a multicenter prospective cohort of 283 patients with chronic graft-versus-host disease requiring systemic treatment. The median follow-up time of survivors was 25.1 months (range, 5.4-47.7 months) after enrollment. Symptom measures included the Lee symptom scale and 10-point patient-reported symptoms. Quality-of-life measures included the Short Form-36, Functional Assessment of Cancer Therapy-Bone Marrow Transplantation, and Human Activities Profile. Overall and organ-specific responses were calculated by comparing manifestations at the 6-month visit and those at the enrollment visit using a provisional algorithm. Complete or partial responses were considered "response," and stable or progressive disease was considered "no response." Overall response rate at 6 months was 32%. Organ-specific response rates were 45% for skin, 23% for eyes, 32% for mouth, and 51% for gastrointestinal tract. Response at 6 months, as calculated according to the provisional response algorithm, was correlated with changes in symptom burden in patients with newly diagnosed chronic graft-versus-host disease, but not with changes in quality of life or survival outcomes. Modification of the algorithm or validation of other more meaningful clinical endpoints is warranted for future clinical trials of treatment for chronic graft-versus-host disease.
KW - Allogeneic
KW - Hematopoietic cell transplantation
KW - National Institutes of Health
KW - Response criteria
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U2 - 10.1016/j.bbmt.2012.05.016
DO - 10.1016/j.bbmt.2012.05.016
M3 - Article
C2 - 22683612
AN - SCOPUS:84866166246
SN - 1083-8791
VL - 18
SP - 1517
EP - 1524
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 10
ER -