Abstract
Acute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft-versus-host disease. We examined outcome following diagnosis of grade II-IV acute graft-versus-host disease according to time period, and explored effects according to original graft-versus-host disease prophylaxis regimen and maximum overall grade of acute graft-versus-host disease. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic leukemia (30%) or myelodysplastic syndromes (14%) received a sibling (24%) or unrelated donor (76%) blood (66%) or marrow (34%) transplant and developed grade II-IV acute graft-versus-host disease (n=497 for 1999-2001, n=962 for 2002-2005, n=1,446 for 2006-2010). The median (range) follow-up was 144 (4-174), 97 (4-147) and 60 (8-99) months for 1999-2001, 2002-2005, and 2006-2010, respectively. Among the cohort with grade II-IV acute graft-versus-host disease, there was a decrease in the proportion of grade III-IV disease over time with 56%, 47%, and 37% for 1999-2001, 2002-2005, and 2006-2012, respectively (P<0.001). Considering the total study population, univariate analysis demonstrated significant improvements in overall survival and treatment-related mortality over time, and deaths from organ failure and infection declined. On multivariate analysis, significant improvements in overall survival (P=0.003) and treatment-related mortality (P=0.008) were only noted among those originally treated with tacrolimus-based graft-versus-host disease prophylaxis, and these effects were most apparent among those with overall grade II acute graft-versus-host disease. In conclusion, survival has improved over time for tacrolimus-treated transplant recipients with acute graft-versus-host disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 958-966 |
| Number of pages | 9 |
| Journal | Haematologica |
| Volume | 102 |
| Issue number | 5 |
| DOIs | |
| State | Published - Apr 30 2017 |
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ASJC Scopus subject areas
- Hematology
Cite this
Improved survival after acute graft-versus-host disease diagnosis in the modern era. / Khoury, Hanna J.; Wang, Tao; Hemmer, Michael T.; Couriel, Daniel; Alousi, Amin; Cutler, Corey; Aljurf, Mahmoud; Battiwalla, Minoo; Cahn, Jean Yves; Cairo, Mitchell; Chen, Yi Bin; Gale, Robert Peter; Hashmi, Shahrukh; Hayashi, Robert J.; Jagasia, Madan; Juckett, Mark; Kamble, Rammurti T.; Kharfan-Dabaja, Mohamed; Litzow, Mark R; Majhail, Navneet; Miller, Alan; Nishihori, Taiga; Qayed, Muna; Antin, Joseph H.; Schoemans, Helene; Schouten, Harry C.; Socie, Gerard; Storek, Jan; Verdonck, Leo; Vij, Ravi; Wood, William A.; Yu, Lolie; Martino, Rodrigo; Carabasi, Matthew; Dandoy, Christopher; Gergis, Usama; Hematti, Peiman; Solh, Melham; Jamani, Kareem; Lehmann, Leslie; Savani, Bipin; Schultz, Kirk R.; Wirk, Baldeep M.; Spellman, Stephen; Arora, Mukta; Pidala, Joseph.
In: Haematologica, Vol. 102, No. 5, 30.04.2017, p. 958-966.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Improved survival after acute graft-versus-host disease diagnosis in the modern era
AU - Khoury, Hanna J.
AU - Wang, Tao
AU - Hemmer, Michael T.
AU - Couriel, Daniel
AU - Alousi, Amin
AU - Cutler, Corey
AU - Aljurf, Mahmoud
AU - Battiwalla, Minoo
AU - Cahn, Jean Yves
AU - Cairo, Mitchell
AU - Chen, Yi Bin
AU - Gale, Robert Peter
AU - Hashmi, Shahrukh
AU - Hayashi, Robert J.
AU - Jagasia, Madan
AU - Juckett, Mark
AU - Kamble, Rammurti T.
AU - Kharfan-Dabaja, Mohamed
AU - Litzow, Mark R
AU - Majhail, Navneet
AU - Miller, Alan
AU - Nishihori, Taiga
AU - Qayed, Muna
AU - Antin, Joseph H.
AU - Schoemans, Helene
AU - Schouten, Harry C.
AU - Socie, Gerard
AU - Storek, Jan
AU - Verdonck, Leo
AU - Vij, Ravi
AU - Wood, William A.
AU - Yu, Lolie
AU - Martino, Rodrigo
AU - Carabasi, Matthew
AU - Dandoy, Christopher
AU - Gergis, Usama
AU - Hematti, Peiman
AU - Solh, Melham
AU - Jamani, Kareem
AU - Lehmann, Leslie
AU - Savani, Bipin
AU - Schultz, Kirk R.
AU - Wirk, Baldeep M.
AU - Spellman, Stephen
AU - Arora, Mukta
AU - Pidala, Joseph
PY - 2017/4/30
Y1 - 2017/4/30
N2 - Acute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft-versus-host disease. We examined outcome following diagnosis of grade II-IV acute graft-versus-host disease according to time period, and explored effects according to original graft-versus-host disease prophylaxis regimen and maximum overall grade of acute graft-versus-host disease. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic leukemia (30%) or myelodysplastic syndromes (14%) received a sibling (24%) or unrelated donor (76%) blood (66%) or marrow (34%) transplant and developed grade II-IV acute graft-versus-host disease (n=497 for 1999-2001, n=962 for 2002-2005, n=1,446 for 2006-2010). The median (range) follow-up was 144 (4-174), 97 (4-147) and 60 (8-99) months for 1999-2001, 2002-2005, and 2006-2010, respectively. Among the cohort with grade II-IV acute graft-versus-host disease, there was a decrease in the proportion of grade III-IV disease over time with 56%, 47%, and 37% for 1999-2001, 2002-2005, and 2006-2012, respectively (P<0.001). Considering the total study population, univariate analysis demonstrated significant improvements in overall survival and treatment-related mortality over time, and deaths from organ failure and infection declined. On multivariate analysis, significant improvements in overall survival (P=0.003) and treatment-related mortality (P=0.008) were only noted among those originally treated with tacrolimus-based graft-versus-host disease prophylaxis, and these effects were most apparent among those with overall grade II acute graft-versus-host disease. In conclusion, survival has improved over time for tacrolimus-treated transplant recipients with acute graft-versus-host disease.
AB - Acute graft-versus-host disease remains a major threat to a successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft-versus-host disease. We examined outcome following diagnosis of grade II-IV acute graft-versus-host disease according to time period, and explored effects according to original graft-versus-host disease prophylaxis regimen and maximum overall grade of acute graft-versus-host disease. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic leukemia (30%) or myelodysplastic syndromes (14%) received a sibling (24%) or unrelated donor (76%) blood (66%) or marrow (34%) transplant and developed grade II-IV acute graft-versus-host disease (n=497 for 1999-2001, n=962 for 2002-2005, n=1,446 for 2006-2010). The median (range) follow-up was 144 (4-174), 97 (4-147) and 60 (8-99) months for 1999-2001, 2002-2005, and 2006-2010, respectively. Among the cohort with grade II-IV acute graft-versus-host disease, there was a decrease in the proportion of grade III-IV disease over time with 56%, 47%, and 37% for 1999-2001, 2002-2005, and 2006-2012, respectively (P<0.001). Considering the total study population, univariate analysis demonstrated significant improvements in overall survival and treatment-related mortality over time, and deaths from organ failure and infection declined. On multivariate analysis, significant improvements in overall survival (P=0.003) and treatment-related mortality (P=0.008) were only noted among those originally treated with tacrolimus-based graft-versus-host disease prophylaxis, and these effects were most apparent among those with overall grade II acute graft-versus-host disease. In conclusion, survival has improved over time for tacrolimus-treated transplant recipients with acute graft-versus-host disease.
UR - http://www.scopus.com/inward/record.url?scp=85018996819&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85018996819&partnerID=8YFLogxK
U2 - 10.3324/haematol.2016.156356
DO - 10.3324/haematol.2016.156356
M3 - Article
C2 - 28302712
AN - SCOPUS:85018996819
VL - 102
SP - 958
EP - 966
JO - Haematologica
JF - Haematologica
SN - 0390-6078
IS - 5
ER -