NYMC Faculty Publications

Impact of Chronic Graft-Versus-Host Disease on Late Relapse and Survival on 7,489 Patients After Myeloablative Allogeneic Hematopoietic Cell Transplantation for Leukemia

Author Type(s)

Faculty

DOI

10.1158/1078-0432.CCR-14-0586

Journal Title

Clinical Cancer Research

First Page

2020

Last Page

2028

Document Type

Article

Publication Date

5-1-2015

Department

Pediatrics

Keywords

Adolescent, Adult, Allografts, Chronic Disease, Female, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Humans, Incidence, Leukemia, Male, Recurrence, Registries, Retrospective Studies, Young Adult

Disciplines

Medicine and Health Sciences

Abstract

PURPOSE: Malignancy relapse remains a major obstacle for successful allogeneic hematopoietic cell transplantation (HCT). Chronic graft-versus-host disease (cGVHD) is associated with fewer relapses. However, when studying effects of cGVHD on relapse, it is difficult to separate from acute GVHD effects as most cases of cGVHD occur within the first year after transplant at the time when acute GVHD is still active.

EXPERIMENTAL DESIGN: This study based on CIBMTR registry data investigated cGVHD and its association with the incidence of late relapse and survival in 7,489 patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndromes (MDS), who were leukemia free at 12 months after myeloablative allogeneic HCT.

RESULTS: Forty-seven percent of the study population was diagnosed with cGVHD at 12 months after transplant. The protective effect of cGVHD on late relapse was present only in patients with CML [RR, 0.47; 95% confidence interval (CI), 0.37-0.59; P < 0.0001). cGVHD was significantly associated with higher risk of treatment-related mortality (TRM; RR, 2.43; 95% CI, 2.09-2.82; P < 0.0001) and inferior overall survival (RR, 1.56; 95% CI, 1.41-1.73; P < 0.0001) for all diseases. In patients with CML, all organ sites and presentation types of cGVHD were equally associated with lower risk of late relapse.

CONCLUSIONS: These results indicate that clinically relevant antileukemia effects of cGVHD on late relapses are present only in CML but not in AML, ALL, or MDS. Chronic GVHD in patients who are 1-year survivors after myeloablative allogeneic HCT is primarily associated with higher TRM and inferior survival.

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