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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
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- Baron, F (author)
- University of Liege, Belgium
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- Labopin, M (author)
- Hop St Antoine, France
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- Niederwieser, D (author)
- University of Leipzig, Germany
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- (creator_code:org_t)
- 2012-05-22
- 2012
- English.
- In: Leukemia. - : Nature Publishing Group. - 0887-6924 .- 1476-5551. ; 26:12, s. 2462-2468
- Journal article (peer-reviewed)
Abstract
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- 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
Keyword
- reduced-intensity conditioning
- AML
- GVHD
- chronic
- graft-versus-leukemia effects
- TECHNOLOGY
- TEKNIKVETENSKAP
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- Baron, F
- Labopin, M
- Niederwieser, D
- Vigouroux, S
- Cornelissen, J J ...
- Malm, Claes
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- Vindelov, L L.
- Blaise, D
- Janssen, J J W M
- Petersen, E
- Socie, G
- Nagler, A
- Rocha, V
- Mohty, M
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- Leukemia
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- Linköping University
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