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Effect of graft-versus-host disease on outcomes of HLA-haploidentical peripheral blood transplantation using post-transplant cyclophophamide

Bone Marrow Transplantation volume 59, pages 66–75 (2024)Cite this article

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Abstract

There is limited evidence regarding the association between graft-versus-host disease (GVHD) and reduced relapse in patients who undergo allogeneic hematopoietic stem cell transplantation from haploidentical donors (haplo-HSCT) using post-transplant cyclophosphamide (PTCY). We investigated the association between GVHD and transplant outcomes in 938 patients who received haplo-HSCT using PTCY. Overall survival (OS), relapse rate, and non-relapse mortality (NRM) were evaluated using landmark analysis at the landmark points at 100 and 360 days after HSCT for acute and chronic GVHD, respectively. Grade I–II acute GVHD was not associated with OS (adjusted hazard ratio: 1.15, 95% confidence interval: 0.85–1.57), relapse (1.03, 0.74–1.45) and NRM (1.15, 0.74–1.77). Conversely, grade III–IV acute GVHD was associated with higher NRM (3.16, 1.61–6.19), but no other outcomes. Limited chronic GVHD was not associated with OS (1.11, 0.48–1.95), relapse (1.05, 0.30–3.75) and NRM (1.30, 0.45–3.79). Extensive chronic GVHD was associated with higher NRM (2.40, 1.03–5.57), but no other outcome. In conclusion, any GVHD was not associated with a reduced relapse rate and improved OS, and Grade III–IV acute GVHD and extensive chronic GVHD were associated with higher NRM in patients who received haplo-HSCT using PTCY.

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Fig. 1: Patient selection flowchart.
Fig. 2: Transplant outcomes in landmark analysis at 100 days after HSCT.
Fig. 3: Subgroup analysis for the effect of grade II acute GVHD.
Fig. 4: Transplant outcomes in landmark analysis at 360 days after HSCT.

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Data availability

The data of this study are not publicly available due to ethical restrictions that it exceeds the scope of the recipient/donor’s consent for research use in the registry. Data may be available from the corresponding author upon reasonable request and with permission of the JSTCT/JDCHCT.

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Acknowledgements

The authors thank all the centers’ physicians and data managers who contributed to data collection on transplantation, the Japanese Data Center for Hematopoietic Cell Transplantation and the Transplant Registry Unified Management Program 2.

Author information

Authors and Affiliations

  1. Department of Hematology, Kobe City Hospital Organization, Kobe City Medical Center General Hospital, Minamimati 2-1-1, Minatojima, Chuo-ku, Kobe, 650-0047, Japan

    Yoshimitsu Shimomura & Nobuhiro Hiramoto

  2. Department of Environmental Medicine and Population Science, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Yoshimitsu Shimomura, Tetsuhisa Kitamura & Tomotaka Sobue

  3. Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan

    Sho Komukai

  4. Jichi Medical University Saitama Medical Center, Division of Hematology, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan

    Yu Akahoshi

  5. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Junya Kanda

  6. Department of Hematology, Hokkaido University Hospital, Kita14, Nishi5, Kita-Ku, Sapporo Hokkaido, 060-8648, Japan

    Hiroyuki Ohigashi

  7. Department of Hematology, Osaka Metropolitan University, Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan

    Hirohisa Nakamae

  8. Division of Hematology and Oncology, Department of Medicine, Kurume University Hospital, 67 Asahi-machi, Kurume-shi, Fukuoka, 830-0011, Japan

    Koji Nagafuji

  9. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takashi Tanaka & Takahiro Fukuda

  10. Department of Hematology, Hamanomachi Hospital, 3-3-1 Nagahama, Chuo-ku, Fukuoka, 810-8539, Japan

    Tetsuya Eto

  11. Department of Hematology, Sapporo Hokuyu Hospital, 6-6-5-1 Higashisapporo, Shiroishiku, Sapporo, 003-0006, Japan

    Shuichi Ota

  12. Department of Hematology, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan

    Yumiko Maruyama

  13. Department of Hematology, Tenri Hospital, 200 Mishima, Tenri, Nara, 632-8552, Japan

    Takashi Akasaka

  14. Department of Hematology and Oncology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Ken-ichi Matsuoka

  15. Hematology, Oncology and Cardiovascular medicine, Kyushu University Hospital, 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka, 812-8582, Japan

    Yasuo Mori

  16. Japanese Data Center for Hematopoietic Cell Transplantation, 1-1 Yazako Kariata, Nagakute, 480-1195, Japan

    Yoshiko Atsuta

  17. Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, 1-1 Yazako Kariata, Nagakute, 480-1195, Japan

    Yoshiko Atsuta

  18. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Seitaro Terakura

Authors
  1. Yoshimitsu Shimomura
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  2. Sho Komukai
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Contributions

YS designed the study, analysed the data, performed the statistical analysis and wrote the first draft of the manuscript. TK, SK and TS critically reviewed the data analysis and the manuscript. All other authors contributed to data collection. All authors approved the final version of the manuscript.

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Correspondence to Yoshimitsu Shimomura.

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Shimomura, Y., Komukai, S., Kitamura, T. et al. Effect of graft-versus-host disease on outcomes of HLA-haploidentical peripheral blood transplantation using post-transplant cyclophophamide. Bone Marrow Transplant 59, 66–75 (2024). https://doi.org/10.1038/s41409-023-02142-w

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