Page 46 - Haematologica May 2022

Ferrata Storti Foundation
Haematologica 2022 Volume 107(5):1054-1063
Improved outcome of patients with graft-versus-host disease after allogeneic hematopoietic cell transplantation for hematologic malignancies over time:
an EBMT mega-file study
Hildegard T. Greinix,1 Dirk-Jan Eikema,2 Linda Koster,3 Olaf Penack,4 Ibrahim Yakoub-Agha,5 Silvia Montoto,6 Christian Chabannon,7
Jan Styczynski,8 Arnon Nagler,9 Marie Robin,10 Stephen Robinson,11
Yves Chalandon,12 Malgorzata Mikulska,13 Stefan Schönland,14
Zinaida Peric,15 Annalisa Ruggeri,16 Francesco Lanza,17 Liesbeth C. de Wreede,18 Mohamad Mohty,19 Grzegorz W. Basak20 and Nicolaus Kröger21
1Department of Medicine, Division of Haematology, Medical University of Graz, Graz, Austria; 2EBMT Statistical Unit, Leiden, the Netherlands; 3EBMT Data Office Leiden, Leiden, the Netherlands; 4Medical Department of Hematology, Oncology and Tumor Immunology, Charité Universitaetsmedizin Berlin, Berlin, Germany; 5Department of Haematology, CHU de Lille, University Lille, INSERM U1286, Infinite, Lille, France;
6St. Bartholomew`s hospital, Barts Health NHS Trust, London, UK; 7Institut Paoli Calmettes, Marseille, France; 8Collegium Medicum, Nicolaus Copernicus University Torun, Bydgoszcz, Poland; 9Hematology and BMT Division, Chaim Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Ramat-Gan, Israel; 10Hematology / Transplantation, Hôpital Saint-Louis, Paris Cedex 10, France; 11Bristol Oncology Centre, Bristol, UK; 12Département d’Oncologie, Service d’Hématologie, Hôpitaux Universitaires de Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland; 13Division of Infectious Diseases, University of Genova, Ospedale Policlinico San Martino, Genova, Italy; 14University Hospital of Heidelberg, Heidelberg, Germany; 15University Hospital Center Rebro, Zagreb, Croatia; 16Hematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; 17Ravenna Hospital, Ravenna, Italy; 18Department of Biomedical Data Sciences, LUMC Leiden, Leiden, the Netherlands; 19Hopital Saint Antoine, Paris Cedex 12, Paris, France; 20Department of Hematology, Oncology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland and 21University Hospital Eppendorf, Hamburg, Germany
ABSTRACT
Acute graft-versus-host disease (aGvHD) remains a major threat to successful outcome following allogeneic hematopoietic cell trans- plantation though advances in prophylaxis and supportive care have been made. The aim of this study is to test whether the incidence and mortality of aGvHD have decreased over time. 102,557 patients with a median age of 47.6 years and with malignancies after first allo- geneic sibling or unrelated donor (URD) transplant were studied in the following periods: 1990-1995, 1996-2000, 2001-2005, 2006-2010 and 2011-2015. Findings: 100-day incidences of aGvHD grades II-IV decreased from 40% to 38%, 32%, 29% and 28%, respectively, over cal- endar time (P<0.001). In multivariate analysis URD, not in complete remission (CR) at transplant or untreated, and female donor for male recipient were factors associated with increased risk whereas the use of ATG/alemtuzumab decreased aGvHD incidence. Median follow-up was 214, 169, 127, 81 and 30 months, respectively, for the periods analyzed. Three-year-survival after aGvHD grades II-IV increased significantly from 38% to 40%, 43%, 44%, and 45%, respectively. In multivariate analysis URD, not in CR at transplant, peripheral blood as stem cell source, female donor for male recipient, and the use of ATG/alemtuzum- ab were associated with increased mortality whereas reduced-intensity conditioning was linked to lower mortality. Mortality increased with increasing patient age but decreased in the recent cohorts. Our analysis demonstrates that aGvHD has decreased over recent decades and also that the survival rates of patients affected with aGvHD has improved.
Cell Therapy & Immunotherapy
Correspondence:
HILDEGARD GREINIX
hildegard.greinix@medunigraz.at
Received: July 3, 2020. Accepted: June 11, 2021. Pre-published: June 24, 2021.
https://doi.org/10.3324/haematol.2020.265769 ©2022 Ferrata Storti Foundation
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