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Effect of graft-versus-host disease on outcomes after pediatric single cord blood transplantation

Bone Marrow Transplantation volume 55, pages 1430–1437 (2020)Cite this article

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Abstract

The effect of GVHD on transplant outcomes after unrelated cord blood transplantation (UCBT) is not yet fully understood. Pediatric patients aged 0–15 years with acute leukemia or myelodysplastic syndrome who underwent their first UCBT (n = 740) were selected from the Japanese registry. Fifty percent of the patients received a UCB unit containing more than 5.0 × 107/kg total nucleated cells. The occurrence of grade III–IV acute GVHD was associated with a higher risk of non-relapse mortality (NRM, hazard ratio [HR] 4.07, P < 0.001) compared with no acute GVHD. Grade I–II acute GVHD was not associated with NRM. The occurrence of grade I–II or grade III–IV acute GVHD was not associated with a relapse risk. These findings showed that grade I–II acute GVHD carried no survival benefit and grade III–IV acute GVHD had an adverse effect (HR 1.68, P = 0.007). The occurrence of limited chronic GVHD was associated with a low risk of overall mortality (HR 0.60, P = 0.045). Severe acute GVHD should be prevented because of its association with high overall mortality and NRM in pediatric single UCBT. Mild acute GVHD provides no overall benefit. Mild chronic GVHD may be beneficial for survival.

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Acknowledgements

We are indebted to all of the physicians and data managers who contributed valuable transplantation data to the JSHCT. We also thank the members of the data management committee of the JSHCT for their assistance. This work was supported in part by 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), JSPS KAKENHI Grant number 18K08325 (JK) and SENSHIN Medical Research Foundation (JK).

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Authors and Affiliations

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

    Junya Kanda

  2. Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Katsutsugu Umeda

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

    Koji Kato & Nao Yoshida

  4. Central Japan Cord Blood Bank, Seto, Japan

    Koji Kato

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

    Makoto Murata

  6. Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan

    Junichi Sugita & Takanori Teshima

  7. Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan

    Souichi Adachi

  8. Department of Hematology/Oncology, Saitama Children’s Medical Center, Saitama, Japan

    Katsuyoshi Koh

  9. Department of Pediatrics, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Maiko Noguchi

  10. Division of Hemato-Oncology/Regenerative Medicine, Kanagawa Children’s Medical Center, Yokohama, Japan

    Hiroaki Goto

  11. Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan

    Maho Sato & Masami Inoue

  12. Department of Pediatrics, Kyushu University Hospital, Fukuoka, Japan

    Yuhki Koga

  13. Department of Pediatrics, Sapporo Medical University School of Medicine, Sapporo, Japan

    Tsukasa Hori

  14. Department of Pediatrics, Hokkaido University Hospital, Sapporo, Japan

    Yuko Cho

  15. Department of Pediatrics, Niigata Cancer Center Hospital, Niigata, Japan

    Atsushi Ogawa

  16. Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Japan

    Yoshiko Hashii

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

    Yoshiko Atsuta

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

    Yoshiko Atsuta

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on behalf of the JSHCT GVHD Working Group

Contributions

JK designed the research, organized the project, performed the statistical analysis, and analyzed the data; KU, KKato, MM, JS, and TT analyzed and interpreted the data; SA, KKoh, MN, HG, NY, MS, YK, TH, YC, AO, MI, YH, 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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Correspondence to Junya Kanda.

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Kanda, J., Umeda, K., Kato, K. et al. Effect of graft-versus-host disease on outcomes after pediatric single cord blood transplantation. Bone Marrow Transplant 55, 1430–1437 (2020). https://doi.org/10.1038/s41409-020-0853-1

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