TY - JOUR
T1 - Impact of graft-versus-host disease on relapse and survival after allogeneic stem cell transplantation for pediatric leukemia
AU - Kato, Motohiro
AU - Kurata, Mio
AU - Kanda, Junya
AU - Kato, Koji
AU - Tomizawa, Daisuke
AU - Kudo, Kazuko
AU - Yoshida, Nao
AU - Watanabe, Kenichiro
AU - Shimada, Hiroyuki
AU - Inagaki, Jiro
AU - Koh, Katsuyoshi
AU - Goto, Hiroaki
AU - Kato, Keisuke
AU - Cho, Yuko
AU - Yuza, Yuki
AU - Ogawa, Atsushi
AU - Okada, Keiko
AU - Inoue, Masami
AU - Hashii, Yoshiko
AU - Teshima, Takanori
AU - Murata, Makoto
AU - Atsuta, Yoshiko
N1 - Publisher Copyright:
© 2018, Macmillan Publishers Limited, part of Springer Nature.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Graft-versus-host disease (GVHD) occasionally leads to morbidity and mortality but is thought to reduce the risk of relapses in patients with a hematological malignancy. However, information on the effect of GVHD in pediatric leukemia is limited. Using a nationwide registry, we retrospectively analyzed 1526 children who underwent allogeneic stem cell transplantation for leukemia. Grades 0–I acute GVHD were associated with a higher relapse rate at three years after transplantation, at 25.4 and 24.3%, respectively, than grades II, III, or IV acute GVHD at 18.9%, 21.2%, and 2.6%, respectively. In contrast, the overall survival curve of the grades 0 and I GVHD groups (79.0% and 79.5%, respectively) approximated that of the grade II GVHD group (76.3%), and the probability of survival was worst in the severe GVHD groups (66.9% for grade III and 42.5% for grade IV). Chronic GVHD also reduced the relapse risk but conferred no survival advantage. Acute lymphoblastic leukemia was more sensitive to acute GVHD than acute myeloid leukemia (AML) while AML was more sensitive to chronic GVHD. Our study reproduced the preventive effects of GVHD against pediatric leukemia relapses but failed to demonstrate a significant survival advantage.
AB - Graft-versus-host disease (GVHD) occasionally leads to morbidity and mortality but is thought to reduce the risk of relapses in patients with a hematological malignancy. However, information on the effect of GVHD in pediatric leukemia is limited. Using a nationwide registry, we retrospectively analyzed 1526 children who underwent allogeneic stem cell transplantation for leukemia. Grades 0–I acute GVHD were associated with a higher relapse rate at three years after transplantation, at 25.4 and 24.3%, respectively, than grades II, III, or IV acute GVHD at 18.9%, 21.2%, and 2.6%, respectively. In contrast, the overall survival curve of the grades 0 and I GVHD groups (79.0% and 79.5%, respectively) approximated that of the grade II GVHD group (76.3%), and the probability of survival was worst in the severe GVHD groups (66.9% for grade III and 42.5% for grade IV). Chronic GVHD also reduced the relapse risk but conferred no survival advantage. Acute lymphoblastic leukemia was more sensitive to acute GVHD than acute myeloid leukemia (AML) while AML was more sensitive to chronic GVHD. Our study reproduced the preventive effects of GVHD against pediatric leukemia relapses but failed to demonstrate a significant survival advantage.
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U2 - 10.1038/s41409-018-0221-6
DO - 10.1038/s41409-018-0221-6
M3 - Article
C2 - 29795428
AN - SCOPUS:85047370395
SN - 0268-3369
VL - 54
SP - 68
EP - 75
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 1
ER -