Effect of graft-versus-host disease on outcomes after pediatric single cord blood transplantation.
Junya KandaKatsutsugu UmedaKoji KatoMakoto MurataJunichi SugitaSouichi AdachiKatsuyoshi KohMaiko NoguchiHiroaki GotoNao YoshidaMaho SatoYuhki KogaTsukasa HoriYuko ChoAtsushi OgawaMasami InoueYoshiko HashiiYoshiko AtsutaTakanori Teshimanull nullPublished in: Bone marrow transplantation (2020)
The effect of GVHD on transplant outcomes after unrelated cord blood transplantation (UCBT) is not yet fully understood. Pediatric patients aged 0-15 years with acute leukemia or myelodysplastic syndrome who underwent their first UCBT (n = 740) were selected from the Japanese registry. Fifty percent of the patients received a UCB unit containing more than 5.0 × 107/kg total nucleated cells. The occurrence of grade III-IV acute GVHD was associated with a higher risk of non-relapse mortality (NRM, hazard ratio [HR] 4.07, P < 0.001) compared with no acute GVHD. Grade I-II acute GVHD was not associated with NRM. The occurrence of grade I-II or grade III-IV acute GVHD was not associated with a relapse risk. These findings showed that grade I-II acute GVHD carried no survival benefit and grade III-IV acute GVHD had an adverse effect (HR 1.68, P = 0.007). The occurrence of limited chronic GVHD was associated with a low risk of overall mortality (HR 0.60, P = 0.045). Severe acute GVHD should be prevented because of its association with high overall mortality and NRM in pediatric single UCBT. Mild acute GVHD provides no overall benefit. Mild chronic GVHD may be beneficial for survival.
Keyphrases
- liver failure
- cord blood
- allogeneic hematopoietic stem cell transplantation
- respiratory failure
- drug induced
- aortic dissection
- risk assessment
- cardiovascular events
- type diabetes
- stem cells
- emergency department
- acute lymphoblastic leukemia
- risk factors
- induced apoptosis
- ejection fraction
- intensive care unit
- bone marrow
- cardiovascular disease
- signaling pathway
- mesenchymal stem cells
- patient reported outcomes