Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma

O. Ringdén, S. Shrestha, G. T. Da Silva, M. J. Zhang, Angela Dispenzieri, M. Remberger, R. Kamble, C. O. Freytes, R. P. Gale, J. Gibson, V. Gupta, L. Holmberg, H. Lazarus, P. McCarthy, K. Meehan, H. Schouten, G. A. Milone, S. Lonial, P. N. Hari

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Abstract

We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42% (95% confidence interval (CI), 35-49%) and of chronic GVHD (cGVHD) at 5 years was 59% (95% CI, 49-69%), with 70% developing extensive cGVHD. In multivariate analysis, aGVHD (≥grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.

Original languageEnglish (US)
Pages (from-to)831-837
Number of pages7
JournalBone Marrow Transplantation
Volume47
Issue number6
DOIs
StatePublished - Jun 2012

Fingerprint

Homologous Transplantation
Recurrence
Survival
Confidence Intervals
Autologous Transplantation
Conditioning (Psychology)
Multiple Myeloma
Proportional Hazards Models
Siblings
Multivariate Analysis
Transplants
Incidence

Keywords

  • allogeneic
  • graft-vs-host disease
  • myeloma
  • reduced intensity

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma. / Ringdén, O.; Shrestha, S.; Da Silva, G. T.; Zhang, M. J.; Dispenzieri, Angela; Remberger, M.; Kamble, R.; Freytes, C. O.; Gale, R. P.; Gibson, J.; Gupta, V.; Holmberg, L.; Lazarus, H.; McCarthy, P.; Meehan, K.; Schouten, H.; Milone, G. A.; Lonial, S.; Hari, P. N.

In: Bone Marrow Transplantation, Vol. 47, No. 6, 06.2012, p. 831-837.

Research output: Contribution to journalArticle

Ringdén, O, Shrestha, S, Da Silva, GT, Zhang, MJ, Dispenzieri, A, Remberger, M, Kamble, R, Freytes, CO, Gale, RP, Gibson, J, Gupta, V, Holmberg, L, Lazarus, H, McCarthy, P, Meehan, K, Schouten, H, Milone, GA, Lonial, S & Hari, PN 2012, 'Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma', Bone Marrow Transplantation, vol. 47, no. 6, pp. 831-837. https://doi.org/10.1038/bmt.2011.192
Ringdén, O. ; Shrestha, S. ; Da Silva, G. T. ; Zhang, M. J. ; Dispenzieri, Angela ; Remberger, M. ; Kamble, R. ; Freytes, C. O. ; Gale, R. P. ; Gibson, J. ; Gupta, V. ; Holmberg, L. ; Lazarus, H. ; McCarthy, P. ; Meehan, K. ; Schouten, H. ; Milone, G. A. ; Lonial, S. ; Hari, P. N. / Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma. In: Bone Marrow Transplantation. 2012 ; Vol. 47, No. 6. pp. 831-837.
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abstract = "We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42{\%} (95{\%} confidence interval (CI), 35-49{\%}) and of chronic GVHD (cGVHD) at 5 years was 59{\%} (95{\%} CI, 49-69{\%}), with 70{\%} developing extensive cGVHD. In multivariate analysis, aGVHD (≥grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.",
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AU - Ringdén, O.

AU - Shrestha, S.

AU - Da Silva, G. T.

AU - Zhang, M. J.

AU - Dispenzieri, Angela

AU - Remberger, M.

AU - Kamble, R.

AU - Freytes, C. O.

AU - Gale, R. P.

AU - Gibson, J.

AU - Gupta, V.

AU - Holmberg, L.

AU - Lazarus, H.

AU - McCarthy, P.

AU - Meehan, K.

AU - Schouten, H.

AU - Milone, G. A.

AU - Lonial, S.

AU - Hari, P. N.

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N2 - We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42% (95% confidence interval (CI), 35-49%) and of chronic GVHD (cGVHD) at 5 years was 59% (95% CI, 49-69%), with 70% developing extensive cGVHD. In multivariate analysis, aGVHD (≥grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.

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