title: Response to immunosuppressive treatment predicts outcome in patients with chronic graft-versus-host disease: a single-center analysis of longitudinal data.
abstract: It has been reported that chronic graft-versus-host disease (cGVHD) is associated with significant morbidity and mortality after allogeneic stem cell transplantation (allo-SCT). The risk of relapse is generally reduced when cGVHD is present, but prognosis may be affected by increased toxicity and/or risk of infection associated with immunosuppressive treatment (IST). We performed a longitudinal data analysis of cGVHD, including the evolution of cGVHD itself over time in response to IST, in a single-center cohort of 313 consecutive patients undergoing allo-SCT. We found that lack of sustained response without withdrawal of IST within 6 months of cGVHD development was associated with higher transplantation-related mortality (hazard ratio, 2.32; 95% confidence interval, 1.24-4.33) compared with cGVHD-free patients. Conversely, response conferred better overall survival (hazard ratio, 0.42; 95% confidence interval, 0.18-0.95). Our analytical approach allowed us to integrate the evolution of cGVHD in a predictive model of transplantation outcome; notably, remission associated with permanent discontinuation of IST within the first 6 months from the occurrence of cGVHD seemed to correlate most closely with final outcome. Further confirmation from larger studies is needed.
authors.affiliation: Institut Paoli-Calmettes, Marseille, France. crocchiolor@ipc.unicancer.fr
authors.forename: Roberto
authors.initials: R
authors.lastname: Crocchiolo
authors.forename: Colombe
authors.initials: C
authors.lastname: Saillard
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.forename: Sabine
authors.initials: S
authors.lastname: Fürst
authors.forename: Jean
authors.initials: J
authors.lastname: El Cheikh
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Claire
authors.initials: C
authors.lastname: Oudin
authors.forename: Angela
authors.initials: A
authors.lastname: Granata
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.forename: Raynier
authors.initials: R
authors.lastname: Devillier
authors.forename: Daniele
authors.initials: D
authors.lastname: Crocchiolo
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists