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Stem cell transplantation

Impact of graft-versus-host disease on outcomes after unrelated cord blood transplantation

Leukemia volume 31, pages 663–668 (2017)Cite this article

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Abstract

The effect of graft-versus-host disease (GVHD) on transplant outcomes after unrelated cord blood transplantation (UCBT) has not been fully elucidated. We analyzed the impact of acute and chronic GVHD on outcomes in adult patients with acute leukemia or myelodysplastic syndrome who underwent their first UCBT (n=2558). The effect of GVHD on outcomes was analyzed after adjusting for other significant variables. The occurrence of GVHD was treated as a time-dependent covariate. The occurrence of grade 1–2 or 3–4 acute GVHD was significantly associated with a lower relapse rate. Grade 3–4 acute GVHD was associated with a higher risk of non-relapse and overall mortality than no acute GVHD, whereas grade 1–2 acute GVHD was associated with a lower risk of non-relapse and overall mortality than no acute GVHD. Limited or extensive chronic GVHD was significantly associated with a lower relapse rate. Limited chronic GVHD was associated with a lower overall and non-relapse mortality than no chronic GVHD. In conclusion, mild acute or chronic GVHD was associated not only with a low risk of relapse but also with a low risk of non-relapse mortality, and provides a survival benefit in UCBT.

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Acknowledgements

We are indebted to all of the physicians and data managers who contributed valuable transplantation data to the Japan Society for Hematopoietic Cell Transplantation. We also thank the members of the data management committee of the Japan Society of Hematopoietic Cell Transplantation for their assistance. This work was supported in part by the Japan Leukemia Research Fund (JK) and the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from the Japan Agency for Medical Research and Development, AMED (YA and JK).

Author contributions

JK designed the research, organized the project, performed the statistical analysis and analyzed the data; TT and MM organized the project and analyzed the data; YM, ST and AW analyzed the data; NU, ST, Y Ono, Y Onishi, HK, NA, Y Ozawa, HO, TS, KO, TI, KK and YA gathered and organized the data; JK wrote the first draft and all other authors contributed to the final version.

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Authors and Affiliations

  1. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    J Kanda

  2. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    J Kanda

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

    Y Morishima

  4. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    S Terakura & M Murata

  5. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    A Wake & N Uchida

  6. Department of Molecular Therapy, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    S Takahashi

  7. Department of Internal Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan

    Y Ono

  8. Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan

    Y Onishi

  9. Department of Hematology, Kanagawa Cancer Center, Kanagawa, Japan

    H Kanamori

  10. Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan

    N Aotsuka

  11. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    Y Ozawa

  12. Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    H Ogawa

  13. Leukemia Research Center, Saiseikai Maebashi Hospital, Maebashi, Japan

    T Sakura

  14. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

    K Ohashi

  15. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    T Ichinohe

  16. Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Kato

  17. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Y Atsuta

  18. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

  19. Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    T Teshima

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  1. J Kanda
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  2. Y Morishima
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  3. S Terakura
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  4. A Wake
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  16. K Kato
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  17. Y Atsuta
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  18. T Teshima
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  19. M Murata
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on behalf of the GVHD Working Group of the Japan Society for Hematopoietic Cell Transplantation

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Correspondence to J Kanda.

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The authors declare no conflict of interest.

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Kanda, J., Morishima, Y., Terakura, S. et al. Impact of graft-versus-host disease on outcomes after unrelated cord blood transplantation. Leukemia 31, 663–668 (2017). https://doi.org/10.1038/leu.2016.288

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  • DOI: https://doi.org/10.1038/leu.2016.288

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