Severity of Chronic Graft-versus-Host Disease and Late Effects Following Allogeneic Hematopoietic Cell Transplantation for Adults with Hematologic Malignancy

Catherine J. Lee, Tao Wang, Karen Chen, Mukta Arora, Ruta Brazauskas, Stephen R. Spellman, Carrie Kitko, Margaret L. MacMillan, Joseph A. Pidala, Sherif M. Badawy, Neel Bhatt, Vijaya R. Bhatt, Zachariah DeFilipp, Miguel A. Diaz, Nosha Farhadfar, Shahinaz Gadalla, Shahrukh Hashmi, Peiman Hematti, Nasheed M. Hossain, Yoshihiro InamotoLazaros J. Lekakis, Akshay Sharma, Scott Solomon, Stephanie J. Lee, Daniel R. Couriel

研究成果: ジャーナルへの寄稿学術論文査読

4 被引用数 (Scopus)

抄録

The study aimed to determine the association of chronic graft-versus-host disease (cGVHD) diagnosis and severity with the development of subsequent neoplasms (SN) and nonmalignant late effects (NM-LE) in 2-year disease-free adult survivors following hematopoietic cell transplantation (HCT) for a hematologic malignancy. To do so, we conducted a retrospective analysis of 3884 survivors of HCT for hematologic malignancy in the Center of International Blood and Marrow Transplant Research database. We conducted a landmark analysis at the 2-year post-transplantation date, comparing first SN and NM-LE in survivors with and without cGVHD. The cumulative incidence (CuI) of SN and NM-LE were estimated through 10 years post-HCT in both groups, with death or disease relapse as a competing risk. Cox proportional hazards models were used to evaluate the associations of cGVHD and its related characteristics with the development of SN and NM-LE. The estimated 10-year CuI of SN in patients with GVHD (n = 2669) and patients without cGVHD (n = 1215) was 15% (95% confidence interval [CI], 14% to 17%) versus 9% (7.2% to 11%) (P <.001). cGVHD by 2 years post-HCT was independently associated with SN (hazard ratio [HR], 1.94; 95% CI, 1.53 to 2.46; P <.0001) with a standardized incidence ratio of 3.2 (95% CI, 2.9 to 3.5; P <.0001). Increasing severity of cGVHD was associated with an increased risk of SN. The estimated 10-year CuI of first NM-LE in patients with and without cGVHD was 28 (95% CI, 26% to 30%) versus 13% (95% CI, 11% to 15%) (P <.001). cGVHD by 2 years post-HCT was independently associated with NM-LE (HR, 2.23; 95% CI, 1.81 to 2.76; P <.0001). Multivariate analysis of cGVHD-related factors showed that increasing severity of cGVHD, extensive grade, having both mucocutaneous and visceral involvement, and receiving cGVHD treatment for >12 months were associated with the greatest magnitude of risk for NM-LE. cGVHD was closely associated with both SN and NM-LE in adult survivors of HCT for hematologic malignancy. Patients identified as having more severe involvement and both mucocutaneous and visceral organ involvement may warrant enhanced monitoring and screening for SNs and NM-LEs. However, caution is warranted when interpreting these results, as patients with cGVHD may have more vigilant post-transplantation health care and surveillance for late effects.

本文言語英語
ページ(範囲)97.e1-97.e14
ジャーナルTransplantation and Cellular Therapy
30
1
DOI
出版ステータス出版済み - 01-2024
外部発表はい

All Science Journal Classification (ASJC) codes

  • 免疫アレルギー学
  • 分子医療
  • 血液学
  • 細胞生物学
  • 移植

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