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- Title
Prognostic relevance of‘early-onset’ graft-versus-host disease following non-myeloablative haematopoietic cell transplantation.
- Authors
Mielcarek, Marco; Burroughs, Lauri; Leisenring, Wendy; Diaconescu, Razvan; Martin, Paul J.; Sandmaier, Brenda M.; Maloney, David G.; Maris, Michael B.; Chauncey, Thomas R.; Shizuru, Judith A.; Blume, Karl G.; Hegenbart, Ute; Niederwieser, Dietger; Forman, Stephen; Bruno, Benedetto; Woolfrey, Ann; Storb, Rainer
- Abstract
We retrospectively analysed outcomes among 395 patients with haematologic malignancies who underwent non-myeloablative haematopoietic cell transplantation (HCT) from human leucocyte antigen (HLA)-matched related (n = 297) or unrelated donors (n = 98) in order to identify a possible correlation between the time of onset of graft-versus-host disease (GVHD) and survival. The non-myeloablative regimen consisted of 2 Gy total body irradiation with or without fludarabine, followed by postgrafting immunosuppression with mycophenolate mofetil and cyclosporine. The cumulative incidences of grades II–IV acute GVHD and extensive chronic GVHD were 45% and 47%, respectively, with related donors, and 68% and 68%, respectively, with unrelated donors. High-dose corticosteroid treatment for acute or chronic GVHD was started at a median of 79 (range, 8–799) days and 30 (range, 5–333) days after transplantation from related and unrelated donors respectively. With related donors, the cumulative incidence of non-relapse mortality among patients with GVHD was 55% at 4 years when prednisone was started before day 50 (n = 72), compared with 29% when treatment was started after day 50 (n = 115) (P < 0·001). With unrelated donors, time to onset of treatment for GVHD was not associated with survival. Patients with early-onset GVHD after non-myeloablative HCT from HLA-identical related donors might benefit from intensified primary immunosuppressive treatment.
- Subjects
GRAFT versus host disease; CELL transplantation; CELLULAR therapy; SURGERY; THERAPEUTICS; PROGNOSIS
- Publication
British Journal of Haematology, 2005, Vol 129, Issue 3, p381
- ISSN
0007-1048
- Publication type
Article
- DOI
10.1111/j.1365-2141.2005.05458.x