Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study
Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study
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DOI：
10.1016/j.leukres.2015.12.009
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发表时间：
2016-02-01
影响因子：
2.7
通讯作者：
Miyazaki, Yasushi
中科院分区：
文献类型：
--
作者：
Itonaga, Hidehiro;Iwanaga, Masako;Miyazaki, Yasushi
异基因造血干细胞移植(allo-HSCT)是一种可能改善慢性粒单核细胞白血病(CMML)患者预后的治疗方案。然而，很少有研究考察移植物抗宿主病(GVHD)分级对CMML移植后预后的影响。我们回顾分析了1987-2010年间接受allo-HSCT的141例CMML患者的预后，并实现了中性粒细胞移植。以aGVHD或cGVHD的发病日期为时间依赖协变量，建立风险回归模型，评价急性GVHD和慢性GVHD对总存活率(OS)、白血病相关死亡率(LAM)和移植相关死亡率的影响。在单变量分析中，与无移植物抗宿主病相比，I级移植物抗宿主病与更好的OS和更低的LAM(分别为P=0.042，P=0.033)相关，但在多因素分析中不相关。多因素分析显示，在移植时未完全缓解的患者中，广泛的移植物抗宿主病与较好的OS(危险比[HR]0.35[95%可信区间(CI)0.16~0.74]；P=0.007)和较低的LAM(HR[HR0.36[95%CI，0.14~0.92]；P=0.033)显著相关。综上所述，cGVHD的发生可能是影响接受移植的CMML患者预后的一个重要因素。(C)2015爱思唯尔有限公司。保留所有权利。
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a therapeutic option that may lead to improved outcomes in patients with chronic myelomonocytic leukemia (CMML). However, few studies have examined the impact of the grade of graft-versus-host disease (GVHD) on post-transplant outcomes for CMML. We retrospectively analyzed the outcomes of 141 patients with CMML who underwent allo-HSCT between 1987 and 2010, and achieved neutrophil engraftment. The effects of acute GVHD (aGVHD) or chronic GVHD (cGVHD) on overall survival (OS), leukemia -associated mortality (LAM), and transplant-related mortality were evaluated by hazards regression models, in which the onset date of aGVHD or cGVHD was treated as a time-dependent covariate. Grade I aGVHD was associated with better OS and lower LAM (P=0.042, P=0.033, respectively) than no GVHD in univariate analyses, but not in the multivariate analyses. The multivariate analyses demonstrated that extensive cGVHD significantly associated with better OS (Hazard Ratio [HR] 0.35 [95% confidence intervals (CI), 0.16-0.74]; P= 0.007) and lower LAM (HR 0.36 [95% CI, 0.14-0.92]; P = 0.033) in patients who were not in complete remission at transplantation. In conclusion, the occurrence of cGVHD may be an important factor affecting the outcomes of CMML patients who received transplantation. (C) 2015 Elsevier Ltd. All rights reserved.