title: Clinical factors predicting the response of acute graft-versus-host disease to corticosteroid therapy: an analysis from the GVHD Working Group of the Japan Society for Hematopoietic Cell Transplantation.
abstract: Systemic corticosteroid therapy is recommended as a first-line treatment for acute graft-versus-host disease (GVHD). We performed a retrospective study to identify the factors affecting the response of grade II to IV acute GVHD to systemic corticosteroid therapy using the Japanese national registry data for patients who received first allogeneic hematopoietic cell transplantation with bone marrow (BM) (n = 1955), peripheral blood stem cells (PBSCs) (n = 642), or umbilical cord blood (UCB) (n = 839). Of 3436 patients, 2190 (63.7%) showed improvement of acute GVHD to first-line therapy with corticosteroids. Various factors were identified to predict corticosteroid response. Interestingly, UCB (versus HLA-matched related BM) transplantation was significantly associated with a higher probability of improvement, whereas HLA-matched unrelated BM and HLA-mismatched stem cell sources other than UCB were significantly associated with a lower probability of improvement. HLA-matched related PBSC transplantation was not significantly different from HLA-matched related BM transplantation. Patients without improvement from corticosteroid therapy had a 2.5-times higher nonrelapse mortality and a .6-times lower overall survival rate. The present study demonstrated, for the first time, a higher probability of improvement in grade II to IV acute GVHD with systemic corticosteroid therapy in patients after UCB transplantation than in those after BM and PBSC transplantation. A prospective study is warranted.
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan. mmurata@med.nagoya-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Murata
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.forename: Takahiko
authors.initials: T
authors.lastname: Nakane
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Furukawa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Takehiko
authors.initials: T
authors.lastname: Mori
authors.forename: Shuichi
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Ohashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Hino
authors.forename: Masami
authors.initials: M
authors.lastname: Inoue
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ogawa
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.forename: Tokiko
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Yabe
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishima
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
authors.forename: Ritsuro
authors.initials: R
authors.lastname: Suzuki
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D007223:Infant; D007564:Japan; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Acute graft-versus-host disease; Cord blood transplantation; Corticosteroid