title: Impact of Chronic Graft-versus-Host Disease on Late Relapse and Survival on 7,489 Patients after Myeloablative Allogeneic Hematopoietic Cell Transplantation for Leukemia.
abstract: OBJECTIVE
  Malignancy relapse remains a major obstacle for successful allogeneic hematopoietic cell transplantation (HCT). Chronic graft-versus-host disease (cGVHD) is associated with fewer relapses. However, when studying effects of cGVHD on relapse, it is difficult to separate from acute GVHD effects as most cases of cGVHD occur within the first year after transplant at the time when acute GVHD is still active.
  
  
  METHODS
  This study based on CIBMTR registry data investigated cGVHD and its association with the incidence of late relapse and survival in 7,489 patients with acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and myelodysplastic syndromes (MDS), who were leukemia free at 12 months after myeloablative allogeneic HCT.
  
  
  RESULTS
  Forty-seven percent of the study population was diagnosed with cGVHD at 12 months after transplant. The protective effect of cGVHD on late relapse was present only in patients with CML [RR, 0.47; 95% confidence interval (CI), 0.37-0.59; P < 0.0001). cGVHD was significantly associated with higher risk of treatment-related mortality (TRM; RR, 2.43; 95% CI, 2.09-2.82; P < 0.0001) and inferior overall survival (RR, 1.56; 95% CI, 1.41-1.73; P < 0.0001) for all diseases. In patients with CML, all organ sites and presentation types of cGVHD were equally associated with lower risk of late relapse.
  
  
  CONCLUSIONS
  These results indicate that clinically relevant antileukemia effects of cGVHD on late relapses are present only in CML but not in AML, ALL, or MDS. Chronic GVHD in patients who are 1-year survivors after myeloablative allogeneic HCT is primarily associated with higher TRM and inferior survival.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. boyiadzism@upmc.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Boyiadzis
authors.affiliation: University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: John P
authors.initials: JP
authors.lastname: Klein
authors.affiliation: Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
authors.forename: Anna
authors.initials: A
authors.lastname: Hassebroek
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Michael
authors.initials: M
authors.lastname: Hemmer
authors.affiliation: Institute of Hematology and Oncology, Hospital Clínic, Boston, Massachusetts.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano-Ispizua
authors.affiliation: Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Bolwell
authors.affiliation: Hopital Michallon, CHU de Grenoble, Grenoble, France.
authors.forename: Jean-Yves Y
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: New York Medical College, Valhalla, New York.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.affiliation: Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Imperial College, London, United Kingdom.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gale
authors.affiliation: University of Louisville Hospital/James Brown Cancer Center, Louisville, Kentucky.
authors.forename: Roger
authors.initials: R
authors.lastname: Herzig
authors.affiliation: Mount Sinai Medical Center, Miami, Florida.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Isola
authors.affiliation: National Medical Center, Washington, DC.
authors.forename: David A
authors.initials: DA
authors.lastname: Jacobsohn
authors.affiliation: Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Madan H
authors.initials: MH
authors.lastname: Jagasia
authors.affiliation: Temple Bone Marrow Transplant Program, Philadelphia, Pennsylvania.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
authors.affiliation: Ospedale Civile BMT Center, Pescara, Italy.
authors.forename: Stella
authors.initials: S
authors.lastname: Santarone
authors.affiliation: Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Spellman
authors.affiliation: Academische Ziekenhuis Maastricht, Maastricht, the Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Isala Clinics, Zwolle, the Netherlands.
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
authors.affiliation: Shands HealthCare and University of Florida, Gainesville, Florida.
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.affiliation: National Cancer Institute, Bethesda, Maryland.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000401:mortality / Q000628:therapy*; D008297:Male; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D055815:Young Adult