Chronic graft-versus-host disease after allogeneic blood stem cell transplantation: long-term results of a randomized study.
The use of peripheral blood stem cells (PBSCs) is rapidly growing in the allogeneic transplantation setting as an alternative to bone marrow (BM). We previously reported a higher incidence of chronic graft-versus-host disease (cGVHD) associated with allogeneic PBSC transplantation in a randomized trial. In this follow-up report, we analyzed the evolution of cGVHD in the patients (n = 101) enrolled on this study. At a median follow-up of 45 months (range, 31-57 months), we found that the 3-year cumulative incidence of cGVHD was 65% (95% confidence interval [CI] 51%-78%) in the PBSC group and 36% (95% CI 23%-49%) in the BM group (P =.004). We also found that extensive cGVHD was more frequent in the PBSC group (44% [95% CI 30%-58%] vs 17% [95% CI 7%-27%]; P =.004). The prevalence of cGVHD was always higher in the PBSC arm. Ocular involvement was more frequent in PBSC recipients (P =.02). Cutaneous and liver involvement was similar among BM and PBSC recipients. Chronic GVHD required multiple courses of immunosuppressive therapy in addition to cyclosporine and corticosteroids during longer periods (P =.03). Altogether, this translated into longer periods of hospitalization after transplantation in the PBSC group (P =.04). Finally, we also confirm that cGVHD after PBSC transplantation is associated with an antileukemic effect that is at least as potent as after BM. However, to date, this has not translated into a survival difference, possibly due to the early-stage leukemic status of these patients or to the relatively small size of the study population.
Mohty
Mohamad
M
Transplantation and Cellular Therapy Unit, Institut Paoli-Calmettes, 232 Boulevard Sainte Marguerite, 132273 Marseille Cedex 09, France.
Kuentz
Mathieu
M
Michallet
Mauricette
M
Bourhis
Jean-Henri
JH
Milpied
Noël
N
Sutton
Laurent
L
Jouet
Jean-Pierre
JP
Attal
Michel
M
Bordigoni
Pierre
P
Cahn
Jean-Yves
JY
Boiron
Jean-Michel
JM
Blaise
Didier
D
D000328:Adult; D002908:Chronic Disease; D015331:Cohort Studies; D018572:Disease-Free Survival; D005123:Eye / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007938:Leukemia / Q000628:therapy; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000473:pathology; D009928:Organ Specificity; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects*; D012008:Recurrence; D012867:Skin / Q000473:pathology; D016019:Survival Analysis; D018183:Transplantation Chimera; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D014781:Viscera / Q000473:pathology
D007166:Immunosuppressive Agents