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Stem Cell Transplantation
Disability related to chronic graft-versus-host disease after alternative donor hematopoietic cell transplantation
Ferrata Storti Foundation
Haematologica 2019 Volume 104(4):835-843
Giancarlo Fatobene,1,2 Barry E. Storer,1 Rachel B. Salit, 1,3Stephanie J. Lee,1,3 Paul J. Martin,1,3 Guang-Shing Cheng,1,3 Paul A. Carpenter,1,3 Gansuvd Balgansuren,3,4 Effie W. Petersdorf,1,3 Colleen Delaney,1,3 Brenda M. Sandmaier,1,3 Filippo Milano1,3 and Mary E. Flowers1,3
1Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA; 2Universidade de Sao Paulo, Hospital das Clinicas, SP, Brazil; 3University of Washington, Division of Medical Oncology, Seattle, WA, USA and 4Seattle Cancer Care Alliance, Seattle, WA, USA
ABSTRACT
We determined the incidence of disability related to chronic graft- versus-host disease (bronchiolitis obliterans, grade ≥2 keratocon- junctivitis sicca, sclerotic features or esophageal stricture) for three categories of alternative donor: cord blood, haplorelated marrow or peripheral blood with post-transplant cyclophosphamide, and unrelated single HLA-allele mismatched peripheral blood. Among 396 consecutive hematopoietic cell transplant recipients, 129 developed chronic graft-ver- sus-host disease with 3-year cumulative incidences of 8% for cord blood, 24% for haplorelated grafts, and 55% for unrelated single HLA- allele mismatched peripheral blood. Disability rates were significantly lower for cord blood [hazard ratio (HR) 0.13; 95% confidence interval (CI): 0.1-0.4] and for the haplorelated group (HR 0.31; 95% CI: 0.1-0.7) compared to the rate in the group transplanted with unrelated single HLA-allele mismatched peripheral blood. Cord blood recipients were also >2-fold more likely to return to work/school within 3 years from the onset of chronic graft-versus-host disease (HR 2.54; 95% CI: 1.1-5.7, P=0.02), and the haplorelated group trended similarly (HR 2.38; 95% CI: 1.0-5.9, P=0.06). Cord blood recipients were more likely to discontinue immunosuppression than were recipients of unrelated single HLA-allele mismatched peripheral blood (HR 3.96; 95% CI: 1.9-8.4, P=0.0003), sim- ilarly to the haplorelated group (HR 4.93; 95% CI: 2.2-11.1, P=0.0001). Progression-free survival and non-relapse mortality did not differ between groups grafted from different types of donors. Our observations that, compared to recipients of unrelated single HLA-allele mismatched peripheral blood, recipients of cord blood and haplorelated grafts less often developed disability related to chronic graft-versus-host disease, and were more likely to resume work/school, should help better counseling of pre-hematopoietic cell transplant candidates.
Introduction
Hematopoietic cell transplantation (HCT) can be accomplished with grafts from alternative donors for patients lacking an HLA-matched related or unrelated donor. The optimal choice of an alternative donor stem cell source remains an open ques- tion and is influenced by several factors including chronic graft-versus-host disease (GvHD). Chronic GvHD is a heterogeneous syndrome associated with major mor- bidity and adverse effects on quality of life and functionality among long-term allo- geneic HCT survivors.1-3 Because a diagnosis of chronic GvHD does not always indicate significant morbidity and poor quality of life, the frequency of severe chronic GvHD manifestations (e.g. severe keratoconjunctivitis sicca, bronchiolitis obliterans, cutaneous scleroderma, joint/fasciae features, and esophageal stricture
Correspondence:
MARY E. D. FLOWERS
mflowers@fhcrc.org.
Received: July 25, 2018.
Accepted: November 8, 2018. Pre-published: November 15, 2018.
doi:10.3324/haematol.2018.202754
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/4/835
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