Prognostic relevance of 'early-onset' graft-versus-host disease following non-myeloablative haematopoietic cell transplantation.

Publication Type:

Journal Article

Source:

British journal of haematology, Volume 129, Issue 3, p.381-91 (2005)

Keywords:

Acute Disease, Adolescent, Adult, Aged, Child, Child, Preschool, Chronic Disease, Drug Administration Schedule, Female, Glucocorticoids, Graft vs Host Disease, Hematologic Neoplasms, hematopoietic stem cell transplantation, Histocompatibility Testing, Humans, Immunosuppression, Infant, Male, Middle Aged, Prednisone, Prognosis, Retrospective Studies, Severity of Illness Index, Sex Factors, Survival Analysis, Time Factors, Transplantation Conditioning, Treatment Outcome, Whole-Body Irradiation

Abstract:

We retrospectively analysed outcomes among 395 patients with haematologic malignancies who underwent non-myeloablative haematopoietic cell transplantation (HCT) from human leucocyte antigen (HLA)-matched related (n = 297) or unrelated donors (n = 98) in order to identify a possible correlation between the time of onset of graft-versus-host disease (GVHD) and survival. The non-myeloablative regimen consisted of 2 Gy total body irradiation with or without fludarabine, followed by postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. The cumulative incidences of grades II-IV acute GVHD and extensive chronic GVHD were 45% and 47%, respectively, with related donors, and 68% and 68%, respectively, with unrelated donors. High-dose corticosteroid treatment for acute or chronic GVHD was started at a median of 79 (range, 8-799) days and 30 (range, 5-333) days after transplantation from related and unrelated donors respectively. With related donors, the cumulative incidence of non-relapse mortality among patients with GVHD was 55% at 4 years when prednisone was started before day 50 (n = 72), compared with 29% when treatment was started after day 50 (n = 115) (P < 0.001). With unrelated donors, time to onset of treatment for GVHD was not associated with survival. Patients with early-onset GVHD after non-myeloablative HCT from HLA-identical related donors might benefit from intensified primary immunosuppressive treatment.