title: Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma.
abstract: We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42% (95% confidence interval (CI), 35-49%) and of chronic GVHD (cGVHD) at 5 years was 59% (95% CI, 49-69%), with 70% developing extensive cGVHD. In multivariate analysis, aGVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.
authors.affiliation: Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.forename: S
authors.initials: S
authors.lastname: Shrestha
authors.forename: G T
authors.initials: GT
authors.lastname: da Silva
authors.forename: M-J
authors.initials: MJ
authors.lastname: Zhang
authors.forename: A
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: M
authors.initials: M
authors.lastname: Remberger
authors.forename: R
authors.initials: R
authors.lastname: Kamble
authors.forename: C O
authors.initials: CO
authors.lastname: Freytes
authors.forename: R P
authors.initials: RP
authors.lastname: Gale
authors.forename: J
authors.initials: J
authors.lastname: Gibson
authors.forename: V
authors.initials: V
authors.lastname: Gupta
authors.forename: L
authors.initials: L
authors.lastname: Holmberg
authors.forename: H
authors.initials: H
authors.lastname: Lazarus
authors.forename: P
authors.initials: P
authors.lastname: McCarthy
authors.forename: K
authors.initials: K
authors.lastname: Meehan
authors.forename: H
authors.initials: H
authors.lastname: Schouten
authors.forename: G A
authors.initials: GA
authors.lastname: Milone
authors.forename: S
authors.initials: S
authors.lastname: Lonial
authors.forename: P N
authors.initials: PN
authors.lastname: Hari
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000628:therapy; D020350:Graft vs Tumor Effect; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous