Allogeneic Hematopoietic Cell Transplantation Following Minimal Intensity Conditioning: Predicting Acute Graft-versus-Host Disease and Graft-versus-Tumor Effects.

Publication Type:

Journal Article

Source:

Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, Volume 19, Issue 5, p.792-8 (2013)

Keywords:

2013, Center-Authored Paper, Clinical Research Division, Collaborative Data Services Core Facility, March 2013, Research Trials Office Core Facility - Biostatistics Service

Abstract:

Most patients with hematologic malignancies have received extensive chemotherapy before hematopoietic cell transplantation (HCT), resulting in neutropenia, lymphocytopenia, and use of antibiotics. Accordingly, patients have a wide range of neutrophil counts, lymphocyte counts, and previous antibiotic use. The minimal toxicity of the current conditioning regimen allowed us to ask whether peritransplantation neutrophil or lymphocyte levels influences the risks of acute graft-versus-host disease (GVHD) or relapse. We analyzed outcomes in 459 patients aged 7-75 years (median, 57 years) who received conditioning with fludarabine and low-dose total body irradiation for HLA-matched HCT. We report 2 key findings. First, low neutrophil nadirs within the first 3 weeks post-HCT had significant associations with increased risk of acute GVHD and 5-year nonrelapse mortality, but no association with the risk of relapse. Second, high lymphocyte counts immediately before HCT had significant associations with reduced risks of relapse and overall mortality, but no association with the risk of GVHD or nonrelapse mortality. These findings suggest that the immunologic mechanisms involved in acute GVHD might differ from those that initiate graft-versus-tumor effects.