Effect of Graft-versus-Host Disease on Post-Transplantation Outcomes following Single Cord Blood Transplantation Compared with Haploidentical Transplantation with Post-Transplantation Cyclophosphamide for Adult Acute Myeloid Leukemia

Takaaki Konuma, Kensuke Matsuda, Yoshimitsu Shimomura, Susumu Tanoue, Junichi Sugita, Yoshihiro Inamoto, Masahiro Hirayama, Takahide Ara, Hirohisa Nakamae, Shuichi Ota, Yumiko Maruyama, Tetsuya Eto, Naoyuki Uchida, Masatsugu Tanaka, Kazuya Ishiwata, Satoshi Koi, Satoshi Takahashi, Yukiyasu Ozawa, Makoto Onizuka, Yoshinobu KandaTakafumi Kimura, Tatsuo Ichinohe, Yoshiko Atsuta, Junya Kanda, Masamitsu Yanada

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

The possibility that HLA mismatches could reduce relapse after alternative HLA-mismatched allogeneic hematopoietic cell transplantation (HCT) is an attractive concept for treating acute myeloid leukemia (AML). However, it remains unclear whether the prognostic effect of graft-versus-host disease (GVHD) on survival differs between recipients of single-unit cord blood transplantation (CBT) and recipients of haploidentical HCT using post-transplantation cyclophosphamide (PTCy-haplo-HCT) for AML. The objective of this retrospective study was to compare the effect of acute GVHD and chronic GVHD on post-transplantation outcomes between recipients of CBT and recipients of PTCy-haplo-HCT. We retrospectively evaluated the effect of acute and chronic GVHD on post-transplantation outcomes following CBT and PTCy-haplo-HCT in adults with AML (n = 1981) between 2014 and 2020 using a Japanese registry database. In univariate analysis, the probability of overall survival was significantly greater in patients who developed grade I-II acute GVHD (P <.001, log-rank test) and limited chronic GVHD (P <.001, log-rank test) among CBT recipients, but these effects were not significant among PTCy-haplo-HCT recipients. In multivariate analysis, in which the development of GVHD was treated as a time-dependent covariate, the effect of grade I-II acute GVHD on reducing overall mortality differed significantly between CBT and PTCy-haplo-HCT (adjusted hazard ratio [HR] for CBT,.73, 95% confidence interval [CI],.60 to.87; adjusted HR for PTCy-haplo-HCT, 1.07; 95% CI,.70 to 1.64; P for interaction =.038). Our data demonstrate that grade I-II acute GVHD was associated with a significant improvement in overall mortality in adults with AML receiving CBT but not in recipients of PTCy-haplo-HCT.

Original languageEnglish
Pages (from-to)365.e1-365.e11
JournalTransplantation and Cellular Therapy
Volume29
Issue number6
DOIs
Publication statusPublished - 06-2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Molecular Medicine
  • Hematology
  • Cell Biology
  • Transplantation

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