ORBi: Baron Frédéric - 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

Reference : Impact of graft-versus-host disease after reduced-intensity conditioning allogeneic stem...


	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Hematology
	To cite this reference:	http://hdl.handle.net/2268/134741

Title :	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
Language :	English
Author, co-author :	Baron, Frédéric [Université de Liège - ULg > > GIGA-R : Hématologie >]
	Labopin, M. []
	Niederwieser, D. []
	Vigouroux, S. []
	Cornelissen, JJ. []
	Malm, C. []
	Vindelov, LL. []
	Blaise, D. []
	Janssen, JJWM []
	Petersen, E. []
	Socié, G. []
	Nagler, A. []
	Rocha, V. []
	Mohty, M. []
Publication date :	Dec-2012
Journal title :	Leukemia : Official Journal of the Leukemia Society of America, Leukemia Research Fund, U.K
Publisher :	Nature Publishing Group
Volume :	26
Issue/season :	12
Pages :	2462-2468
Audience :	International
ISSN :	0887-6924
e-ISSN :	1476-5551
City :	London
Country :	United Kingdom
Keywords :	[en] reduced-intensity conditioning ; AML ; GVHD ; chronic ; graft-versus-leukemia effects
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)¼0.7, P¼0.02) translating into a trend for better overall survival (OS; HR¼1.3; P¼0.07). Grade II acute GVHD had no net impact on OS, while grade III–IV acute GVHD was associated with a worse OS (HR¼0.4, Po0.0.001) owing to high risk of nonrelapse mortality (NRM; HR¼5.2, Po0.0001). In time-dependent multivariate Cox analyses, limited chronic GVHD tended to be associated with a lower risk of relapse (HR¼0.72; P¼0.07) translating into a better OS (HR¼1.8; Po0.001), while extensive chronic GVHD was associated with a lower risk of relapse (HR¼0.65; P¼0.02) but also with higher NRM (HR¼3.5; Po0.001) 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 (Po0.001), but without improving OS for ATG and even with worsening OS for alemtuzumab (HR¼0.65; P¼0.001). 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.
Permalink :	http://hdl.handle.net/2268/134741

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