title: Chronic graft versus host disease but not the intensity of conditioning has impact on survival after allogeneic hematopoietic stem cell transplantation for advanced hematological diseases.
abstract: BACKGROUND
  Allogeneic hematopoietic stem cell transplantation (alloHSCT) is often performed in cases of advanced hematological diseases, but because of the associated mortality and a high risk of relapse it is life prolonging only in some patients.
  
  
  METHODS
  A retrospective multi-center analysis of 401 patients was conducted to analyze the variables associated with outcome after alloHSCT in advanced hematological diseases. The Cox proportional hazards model was used to assess the independence of overall survival (OS) and disease-free survival (DFS) from prognostic factors in a multivariate model.
  
  
  RESULTS
  The 5-year OS and DFS were 27.3 and 21.1% respectively. Multivariate analysis showed that the underlying malignancy had a significant influence on OS and DFS (p < 0.001 and p < 0.011, respectively), whereas development of severe acute graft versus host disease (GvHD) had a negative impact on OS (p < 0.001). Development of chronic GvHD showed a trend to a better OS (p = 0.085) and DFS (p = 0.199). No impact was seen for the intensity of conditioning.
  
  
  CONCLUSIONS
  Development of chronic GvHD but not the conditioning regimen improved the outcome after alloHSCT for advanced malignancies, underlining the importance of immunological rather than cytotoxic effects.
authors.affiliation: Department of Hematology, Oncology, Palliative Care, University of Rostock, Germany. inken.hilgendorf@med.uni-rostock.de
authors.forename: Inken
authors.initials: I
authors.lastname: Hilgendorf
authors.forename: Daniel
authors.initials: D
authors.lastname: Wolff
authors.forename: Axel
authors.initials: A
authors.lastname: Nogai
authors.forename: Günther
authors.initials: G
authors.lastname: Kundt
authors.forename: Joachim
authors.initials: J
authors.lastname: Hahn
authors.forename: Ernst
authors.initials: E
authors.lastname: Holler
authors.forename: Lutz
authors.initials: L
authors.lastname: Uharek
authors.forename: Christian
authors.initials: C
authors.lastname: Junghanss
authors.forename: Malte
authors.initials: M
authors.lastname: Leithäuser
authors.forename: Eckhard
authors.initials: E
authors.lastname: Thiel
authors.forename: Mathias
authors.initials: M
authors.lastname: Freund
authors.forename: Christoph
authors.initials: C
authors.lastname: Kahl
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000401:mortality*; D006402:Hematologic Diseases / Q000401:mortality* / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D066298:In Vitro Techniques; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult