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G. Fatobene et al.
UCB or Haplo/PTCY HCT. Fifth, we were unable to assess quality of life in this study, because very few patients had outcomes based on validated measurement instruments. Sixth, the duration of immunosuppression may be driven ultimately by the selection of stem cell sources associated with a higher risk of severe chronic GvHD (i.e., unrelated mobilized blood cells) or with a lower risk of severe chronic GvHD (i.e., UCB or Haplo/PTCY). Seventh, some manifestations of chronic GvHD may have been underreported in this retrospective study (e.g., genital or lung involvement) Lastly, the analy- sis of functional endpoints at 3 years is limited by the small numbers.
In conclusion, our results show that compared to 1- mMUD recipients, UCB and Haplo/PTCY HCT recipients were less likely to develop chronic GvHD, were less likely to develop disability related to chronic GvHD, had a shorter duration of systemic treatment for chronic GvHD and returned to work or school earlier. While our data do not imply superiority of one alternative transplant strategy ver- sus another (e.g. Haplo/PTCY versus 1-mMUD peripheral
blood versus UCB), the current study provides detailed information regarding disability related to chronic GvHD when it occurs after alternative donor HCT. These findings should help transplant providers to counsel pre-HCT candi- dates better. Determination of disability associated with chronic GvHD is necessary in prospective studies testing alternative donor graft products such as Haplo/PTCY versus UCB to evaluate the overall efficacy of these strategies.
Acknowledgments
We thank Chris Davis, Kevin Bray and Aaron Johnson for their help in retrieving and assembling the data. We also thank Helen Crawford for assistance in submission of this paper.
Funding
This work was supported in part by grants from the National Institutes of Health, National Cancer Institute (CA018029, CA118953, P30 CA015704) and in part by the National Heart, Lung and Blood Institute (HL122173). GF was supported by a grant from the Division of Hematology and Transfusion Medicine of the University of Sao Paulo, SP, Brazil.
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