Occurrence of graft-versus-host disease increases mortality after umbilical cord blood transplantation for acute myeloid leukaemia: a report from Eurocord and the ALWP of the EBMT
Occurrence of graft-versus-host disease increases mortality after umbilical cord blood transplantation for acute myeloid leukaemia: a report from Eurocord and the ALWP of the EBMT
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DOI：
10.1111/joim.12696
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发表时间：
2018-02-01
影响因子：
11.1
通讯作者：
Nagler, A.
中科院分区：
文献类型：
--
作者：
Baron, F.;Ruggeri, A.;Nagler, A.
脐带血移植（UCBT）治疗急性髓系白血病（AML）的疗效依赖于免疫介导的移植物抗白血病效应。以前的研究表明，移植物抗宿主病（GVHD）的发生和移植物抗白血病的影响后，异基因造血细胞transplantation.MethodsHere，我们评估了UCBT后的GVHD发生的相关性复发率的动力学之间有很强的关联。通过计算连续90天间隔内每患者年的复发率，评估复发率随时间变化的动力学与GVHD发生的相关性。GVHD对复发和死亡率的影响进行了进一步研究，在多变量考克斯模型处理GVHD作为一个时间依赖性covariate.ResultsThe研究包括数据从1068例患者给予单（n=567）或双（n=501）UCBT。Ⅱ、Ⅲ、Ⅳ级急性GVHD患者比例分别为20%、7%和4%。2年时，慢性GVHD的累积发生率为42%，累积复发率为32%，总生存率为32%。在移植后的前30个月内，复发率随着时间的推移逐渐下降。可能提示II-IV级急性（HR=0.8，P=0.1）和慢性（HR=0.65，P=0.1）GVHD降低复发风险。然而，II-IV级急性GVHD显著增加早期（UCBT后前18个月）死亡率（HR=1.3，P=0.02），而慢性GVHD则增加早期（HR=2.7，P
BackgroundThe efficacy of umbilical cord blood transplantation (UCBT) as treatment for acute myeloid leukaemia (AML) relies on immune-mediated graft-versus-leukaemia effects. Previous studies have suggested a strong association between graft-versus-host disease (GVHD) occurrence and graft-versus-leukaemia effects after allogeneic hematopoietic cell transplantation.MethodsHere, we evaluated the kinetics of relapse rate in correlation with GVHD occurrence after UCBT. The kinetics of relapse rate over time in correlation to GVHD occurrence were assessed by calculating the relapse rate per patient-year within sequential 90-day intervals. The impact of GVHD on relapse and mortality was further studied in multivariate Cox models handling GVHD as a time-dependent covariate.ResultsThe study included data from 1068 patients given single (n=567) or double (n=501) UCBT. The proportion of patients with grade II, III and IV acute GVHD was 20%, 7% and 4%, respectively. At 2years, the cumulative incidence of chronic GVHD was 42%, the cumulative incidence of relapse was 32%, and overall survival was 32% as well. Relapse rates declined gradually over time during the first 30months after transplantation. There was a possible suggestion that grade II-IV acute (HR=0.8, P=0.1) and chronic (HR=0.65, P=0.1) GVHD decreased relapse risk. However, grade II-IV acute GVHD significantly increased early (the first 18months after UCBT) mortality (HR=1.3, P=0.02), whilst chronic GVHD increased each early (HR=2.7, P