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Graft-Versus-Host Disease

Clinical impact of graft-versus-host disease against leukemias not in remission at the time of allogeneic hematopoietic stem cell transplantation from related donors. The Japan Society for Hematopoietic Cell Transplantation Working Party

Bone Marrow Transplantation volume 34, pages 711–719 (2004)Cite this article

Summary:

Acute graft-versus-host disease (GVHD) increases post-transplant mortality and morbidity, but exerts a potent graft-versus-leukemia (GVL) effect. To clarify the impact of GVHD on outcome after transplant in aggressive diseases, patients with acute myeloid or lymphoblastic leukemia (AML, n=366 or ALL, n=255) in nonremission states, or chronic myelogenous leukemia (CML, n=180) in accelerated phase (AP) or blastic crisis (BC), who received allogeneic hematopoietic stem cell transplantation (HSCT) from a related donor between 1991 and 2000, were analyzed. Significant improvement in overall and disease-free survival (DFS) was detected with grade I acute GVHD in AML (P=0.0002 for overall survival and 0.0009 for DFS, respectively) and in CML (P=0.0256 and 0.0366, respectively), while the trend towards improved survival was observed in ALL. Relapse rate was lower in grade I acute GVHD than in grade II in all three diseases, suggesting that treatment for grade II GVHD may compromise the GVL effect associated with GVHD. Chronic GVHD was found to suppress relapse in CML and ALL, but not in AML, although no improvement in survival was observed in any disease category. Our results suggest that treatment for grade II acute GVHD may need to be attenuated in transplant for refractory leukemias.

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Authors and Affiliations

  1. Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tsukiji, Chuo-ku, Tokyo, Japan

    I Kataoka, M Kami & S Mineishi

  2. Department of Hematology/Oncology Institute of Medical Science, University of Tokyo, Shirokanedai, Minato-ku, Tokyo, Japan

    S Takahashi

  3. Japanese Red Cross Nagoya First Hospital, Michishita-cho, Nakamura-ku, Nagoya, Japan

    Y Kodera

  4. Saiseikai Maebashi Hospital, Kamishinden-machi, Maebashi, Gunma, Japan

    S Miyawaki

  5. Department of Hematology, Nagoya Daini Red Cross Hospital, Myoken-cho, Showa-ku, Nagoya, Japan

    N Hirabayashi

  6. Division of Hematology, Department of Internal Medicine, Keio University School of Medicine, Shinano-machi, Shinjuku-ku, Tokyo, Japan

    S Okamoto

  7. First Department of Internal Medicine, Kansai Medical University, Fumizono-cho, Moriguchi, Osaka, Japan

    N Matsumoto

  8. Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Science, Sakamoto, Nagasaki, Japan

    Y Miyazaki

  9. JA Aichi Showa Hospital, Nobaku, Nobaku-cho, Konan, Aichi, Japan

    Y Morishita

  10. Hematopoietic Cell Therapy Center, Jikei University Hospital, Nishi-Shinbashi, Minato-ku, Tokyo, Japan

    O Asai

  11. Department of Hematology, Kanagawa Cancer Center, Nakao, Asahi-ku, Yokohama, Kanagawa, Japan

    A Maruta

  12. Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan

    T Yoshida

  13. Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Kita-ku, Sapporo, Japan

    M Imamura

  14. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan

    N Hamajima

  15. Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan

    K Matsuo

  16. First Department of Internal Medicine, Kyushu University Graduate School of Medical Science, Fukuska, Japan

    M Harada

  17. Hematology/Hematopoietic Stem Cell Transplant Division, Vanderbilt University Medical Center, Nashville, TN, USA

    S Mineishi

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  1. I Kataoka
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  14. M Imamura
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  15. N Hamajima
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  18. S Mineishi
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Correspondence to S Mineishi.

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Kataoka, I., Kami, M., Takahashi, S. et al. Clinical impact of graft-versus-host disease against leukemias not in remission at the time of allogeneic hematopoietic stem cell transplantation from related donors. The Japan Society for Hematopoietic Cell Transplantation Working Party. Bone Marrow Transplant 34, 711–719 (2004). https://doi.org/10.1038/sj.bmt.1704659

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  • DOI: https://doi.org/10.1038/sj.bmt.1704659

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