TY - JOUR
T1 - 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
AU - Konuma, Takaaki
AU - Matsuda, Kensuke
AU - Shimomura, Yoshimitsu
AU - Tanoue, Susumu
AU - Sugita, Junichi
AU - Inamoto, Yoshihiro
AU - Hirayama, Masahiro
AU - Ara, Takahide
AU - Nakamae, Hirohisa
AU - Ota, Shuichi
AU - Maruyama, Yumiko
AU - Eto, Tetsuya
AU - Uchida, Naoyuki
AU - Tanaka, Masatsugu
AU - Ishiwata, Kazuya
AU - Koi, Satoshi
AU - Takahashi, Satoshi
AU - Ozawa, Yukiyasu
AU - Onizuka, Makoto
AU - Kanda, Yoshinobu
AU - Kimura, Takafumi
AU - Ichinohe, Tatsuo
AU - Atsuta, Yoshiko
AU - Kanda, Junya
AU - Yanada, Masamitsu
N1 - Publisher Copyright:
© 2023 The American Society for Transplantation and Cellular Therapy
PY - 2023/6
Y1 - 2023/6
N2 - 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.
AB - 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.
KW - Acute myeloid leukemia
KW - Cord blood transplantation
KW - Graft-versus-host disease
KW - Graft-versus-leukemia effect
KW - Haploidentical transplantation
KW - Posttransplant cyclophosphamide
UR - https://www.scopus.com/pages/publications/85152702384
UR - https://www.scopus.com/pages/publications/85152702384#tab=citedBy
U2 - 10.1016/j.jtct.2023.03.001
DO - 10.1016/j.jtct.2023.03.001
M3 - Article
C2 - 36889507
AN - SCOPUS:85152702384
SN - 2666-6375
VL - 29
SP - 365.e1-365.e11
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
IS - 6
ER -