Page 176 - Haematologica-April 2018

W.R. Drobyski et al.
AB
CD
EF
GH
Figure 1. Engraftment, GvHD, disease-free survival, and overall survival. (A). Cumulative incidence of achieving an absolute neu- trophil count >500/mm3 for three consecutive days. (B). Cumulative incidence of patients that achieved an unsupported platelet count > 20,000/mm3. Five patients never dropped their
platelet count
20,000. (C,D). Cumulative incidence of grades II-IV and grades III-IV aGvHD. (E). Cumulative incidence of grades II-IV aGvHD in patients that received mye- loablative (MA) versus reduced intensity (RIC) preparative regimens. (F). Cumulative incidence of NIH-defined cGvHD. (G) Probability of disease-free survival and (H) overall sur- vival in patients that received Toc/Tac/MTX as GvHD prophylaxis. Dashed gray lines indicate 95% con- fidence interval bands.
below
720
Twenty-one patients received granulocyte-colony stimu- lating factor (G-CSF) for 1-3 days on days 14-19 post- transplantation to accelerate white blood cell (WBC) recovery. The platelet count in five patients never dropped below 20,000. Two additional patients died before achiev- ing engraftment of platelets. In the remaining patients, the median time to platelet engraftment was 17 days (range: 10-103) (Figure 1B). Chimerism studies conducted on day 28 post-transplantation were available for 33 patients. Median donor CD3 chimerism was 88% (range: 34-100), while median CD33 chimerism was 100% (range: 97- 100). Day 100 studies were performed in 27 patients and revealed a median donor CD3 chimerism of 91% (range: 43-100) and CD33 chimerism of 100% (range: 91-100).
GvHD, transplant-related mortality, relapse, and survival
The cumulative incidence of grades II-IV aGvHD at days 100 and 180 was 14% (95% CI 5-30%) and 17%
(95% CI 7-35%), respectively, (Figure 1C). The inci- dence of grades III-IV aGvHD at these same time points was 3% (95% CI 0-11%) and 6% (95% CI 1-16), respec- tively, (Figure 1D). All patients who developed ≥ grade II aGvHD within the first 100 days had isolated involve- ment of the skin or upper GI tract. Three patients had GvHD of the skin, one of whom developed grade IV dis- ease, which proved to be fatal. Three patients had upper GI tract involvement, which was resolved in each case with modest doses of steroids. There were no cases of aGvHD involving the liver or lower GI tract within this time interval. One patient did develop grade II-IV aGvHD involving the lower GI tract between days 100- 180 post-transplantation. A second patient with a prior history of overall grade III skin involvement developed upper GI tract disease in the duodenum on day 177. The cumulative incidence of grades II-IV aGvHD for each individual tissue site is shown in Online Supplementary Figure S1. There was no difference in the incidence of
haematologica | 2018; 103(4)