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Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia: a report from the Acute Leukemia Working Party of the European group for blood and marrow transplantation
University of Liege, Belgium .
Hop St Antoine, France .
University of Leipzig, Germany .
University Hospital, France University of Bordeaux 2, France .
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2012 (English)In: Leukemia, ISSN 0887-6924, E-ISSN 1476-5551, Vol. 26, no 12, 2462-2468 p.Article in journal (Refereed) Published
Abstract [en]

This report investigated the impact of graft-versus-host disease (GVHD) on transplantation outcomes in 1859 acute myeloid leukemia patients given allogeneic peripheral blood stem cells after reduced-intensity conditioning (RIC allo-SCT). Grade I acute GVHD was associated with a lower risk of relapse (hazards ratio (HR) 0.7, P = 0.02) translating into a trend for better overall survival (OS; HR 1.3; P = 0.07). Grade II acute GVHD had no net impact on OS, while grade III-IV acute GVHD was associated with a worse OS (HR 0.4, P andlt; 0.0.001) owing to high risk of nonrelapse mortality (NRM; HR 5.2, P andlt; 0.0001). In time-dependent multivariate Cox analyses, limited chronic GVHD tended to be associated with a lower risk of relapse (HR 0.72; P = 0.07) translating into a better OS (HR 1.8; P andlt; 0.001), while extensive chronic GVHD was associated with a lower risk of relapse (HR 0.65; P = 0.02) but also with higher NRM (HR 3.5; P andlt; 0.001) and thus had no net impact on OS. In-vivo T-cell depletion with antithymocyte globulin (ATG) or alemtuzumab was successful at preventing extensive chronic GVHD (P andlt; 0.001), but without improving OS for ATG and even with worsening OS for alemtuzumab (HR 0.65; P = 0.001). These results highlight the role of the immune-mediated graft-versus-leukemia effect in the RIC allo-SCT setting, but also the need for improving the prevention and treatment of severe GVHD. Leukemia (2012) 26, 2462-2468; doi: 10.1038/leu.2012.135

Place, publisher, year, edition, pages
Nature Publishing Group , 2012. Vol. 26, no 12, 2462-2468 p.
Keyword [en]
reduced-intensity conditioning, AML, GVHD, chronic, graft-versus-leukemia effects
National Category
Engineering and Technology
URN: urn:nbn:se:liu:diva-87465DOI: 10.1038/leu.2012.135ISI: 000312186000003OAI: diva2:589476

Funding Agencies|Genzyme||Fresenius||Senior Research Associate at the National Fund for Scientific Research (FNRS) Belgium||

Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2013-02-12Bibliographically approved

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Malm, Claes
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Department of Haematology UHL
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