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Graft-versus-Host Disease

Time to first flare-up episode of GVHD can stratify patients according to their prognosis during clinical course of progressive- or quiescent-type chronic GVHD

Bone Marrow Transplantation volume 40, pages 779–784 (2007)Cite this article

Abstract

GVHD-specific survival (GSS) has been investigated as a potential study end point to describe the clinical course and outcome of chronic GVHD (cGVHD). However, reaching this end point requires a long observation time. We hypothesized that the time to the first flare-up (FFU) of cGVHD (TTF) can be an alternative statistical end point to GSS. This retrospective study included 96 patients with a diagnosis of cGVHD from a cohort of 119 patients with a prior history of acute GVHD. The median TTF was 73 days after the diagnosis of cGVHD. The 2-year cumulative incidences of first, second and third episodes of flare-up (FU) during courses of cGVHD were estimated as 69.5, 46.4 and 22.1%. Those patients who did not have an episode of FU of cGVHD had 96.0% of 2-years GSS rate, while those with 1 and ⩾2 episodes had 50.8 and 46.8%, respectively (P=0.001). Shorter TTF was associated with poor GSS and decreased overall survival. The shorter TTF during the course of cGVHD was significantly associated with extensive cGVHD (P=0.002), Hopkins' risk category (P=0.022) and progressive-type cGVHD (P<0.001) in multivariate analysis. We propose that TTF can be an alternative end point to GSS in cGVHD trials.

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Acknowledgements

We gratefully thank Dr Melania Pintilie (Department of Biostatistics, Princess Margaret Hospital, University of Toronto, ON, Canada) to help performing statistical analyses for the cumulative incidence considering competing risks, and to Dr Gizelle Popradi (Department of Hematology/Oncology, Princess Margaret Hospital, University of Toronto, ON, Canada) for her critical review and revision of the paper.

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Authors and Affiliations

  1. Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu, Korea

    D H Kim, S K Sohn & J H Baek

  2. Department of Hematology, University of Ulsan, Asan Medical Center, Seoul, Korea

    K-H Lee, J-H Lee & S-J Choi

  3. Department of Biostatistics, Taegu Catholic University, School of Medicine, Daegu, Korea

    I-H Shin

  4. Department of Hematology/Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    D H Kim

  5. Department of Hematology/Oncology, Ulsan University Hospital, University of Ulsan, Ulsan, Korea

    J H Baek

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  1. D H Kim
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Correspondence to D H Kim.

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Kim, D., Sohn, S., Baek, J. et al. Time to first flare-up episode of GVHD can stratify patients according to their prognosis during clinical course of progressive- or quiescent-type chronic GVHD. Bone Marrow Transplant 40, 779–784 (2007). https://doi.org/10.1038/sj.bmt.1705806

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