Graft-versus-leukaemia effect in children: chronic GVHD has a significant impact on relapse and survival.
To examine whether graft-versus-host-disease (GVHD) is associated with a graft-versus-leukaemia (GVL) effect that also influences the outcome of allogeneic stem cell transplantation (SCT) in childhood acute leukaemia, we evaluated all consecutive (n=169) children who had undergone SCT for ALL and AML at our centre. Median follow-up was 7 years. The 5-year probability of chronic GVHD was 34%. Median time to relapse was 24 months in children with chronic GVHD and 6 months in those without. The corresponding 5-year probabilities of relapse were 30 and 45% (P=0.01). The 5-year probability of survival was 54%. Patients with chronic GVHD had a significantly better survival, 77 vs 51% (P=0.01). In a Cox regression model, chronic GVHD independently decreased the risk of relapse (RR 0.44) and further predicted an increased chance of relapse-free survival (RR 1.7) and survival (RR 2.6). The impact of chronic GVHD on survival was most apparent in late-stage disease and in ALL. Acute GVHD was not an independent predictor for relapse or death in this study. This study is in support of a GVL effect in childhood leukaemia related to chronic GVHD, reducing the risk of relapse and improving survival.
Gustafsson Jernberg
A
A
Department of Paediatrics, Karolinska Institutet, Huddinge University Hospital, Huddinge, Sweden.
Remberger
M
M
Ringdén
O
O
Winiarski
J
J
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000503:physiopathology*; D020544:Graft vs Leukemia Effect; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D011237:Predictive Value of Tests; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D014184:Transplantation, Homologous