title: Impact of graft-versus-host disease on outcomes after allogeneic hematopoietic cell transplantation for adult T-cell leukemia: a retrospective cohort study.
abstract: Allogeneic hematopoietic cell transplantation (HCT) is an effective treatment for adult T-cell leukemia (ATL), raising the question about the role of graft-versus-leukemia effect against ATL. In this study, we retrospectively analyzed the effects of acute and chronic graft-versus-host disease (GVHD) on overall survival, disease-associated mortality, and treatment-related mortality among 294 ATL patients who received allogeneic HCT and survived at least 30 days posttransplant with sustained engraftment. Multivariate analyses treating the occurrence of GVHD as a time-varying covariate demonstrated that the development of grade 1-2 acute GVHD was significantly associated with higher overall survival (hazard ratio [HR] for death, 0.65; P = .018) compared with the absence of acute GVHD. Occurrence of either grade 1-2 or grade 3-4 acute GVHD was associated with lower disease-associated mortality compared with the absence of acute GVHD, whereas grade 3-4 acute GVHD was associated with a higher risk for treatment-related mortality (HR, 3.50; P < .001). The development of extensive chronic GVHD was associated with higher treatment-related mortality (HR, 2.75; P = .006) compared with the absence of chronic GVHD. Collectively, these results indicate that the development of mild-to-moderate acute GVHD confers a lower risk of disease progression and a beneficial influence on survival of allografted patients with ATL.
authors.affiliation: Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawaharacho, Sakyo-ku, Kyoto, Japan.
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.forename: Masakatsu
authors.initials: M
authors.lastname: Hishizawa
authors.forename: Atae
authors.initials: A
authors.lastname: Utsunomiya
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Yukiyoshi
authors.initials: Y
authors.lastname: Moriuchi
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.forename: Fumio
authors.initials: F
authors.lastname: Kawano
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Masato
authors.initials: M
authors.lastname: Masuda
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hara
authors.forename: Minoko
authors.initials: M
authors.lastname: Takanashi
authors.forename: Shunro
authors.initials: S
authors.lastname: Kai
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
authors.forename: Takakazu
authors.initials: T
authors.lastname: Kawase
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Tokiko
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.forename: Shunichi
authors.initials: S
authors.lastname: Kato
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Jun
authors.initials: J
authors.lastname: Okamura
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ichinohe
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult