title: Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation.
abstract: The impact of the conditioning intensity and TBI on acute GVHD (aGVHD) is still a matter of debate. We analyzed 6848 adult recipients who received allogeneic hematopoietic cell transplants (HCT) between 2006 and 2011 in Japan. The subjects were divided into groups who had received myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC), either with or without TBI. There was a significant difference in the incidence of aGVHD 2-4 among the different conditioning types: 39% in TBI-MAC, 35% in TBI-RIC and 32% in both no-TBI MAC and no-TBI-RIC (P<0.001). In a multivariate analysis, TBI-MAC, but not no-TBI MAC, was significantly associated with an increased risk of aGVHD 2-4 (hazard ratio (HR) 1.33, P<0.01), whereas TBI-RIC was associated with an increased risk of GVHD 3-4 (HR 1.36, P=0.048). TBI-MAC and TBI-RIC were significantly associated with skin and gastrointestinal aGVHD. Subgroup analyses demonstrated that not only TBI-MAC, but also TBI-RIC, was significantly associated with aGVHD 2-4 in older patients. Furthermore, high-dose TBI only had an adverse impact on aGVHD 2-4 in HLA-matched HCT. Impacts of intensity and TBI on aGVHD differ by patient backgrounds, and this difference should be considered to establish a risk-adapted strategy for the prevention of aGVHD.
authors.affiliation: 1] Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA [2] Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Nakasone
authors.affiliation: Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Fukuda
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Kanda
authors.affiliation: Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Mori
authors.affiliation: Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Yano
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer & Infectious Disease Center, Komagome Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Miyamura
authors.affiliation: Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Eto
authors.affiliation: Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kanamori
authors.affiliation: Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors, Hiroshima, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Iwato
authors.affiliation: Department of Hematology, Toranomon Hospital, Tokyo, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Uchida
authors.affiliation: Division of Hematology and Oncology, St Luke's International Hospital, Tokyo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Cell Processing and Transfusion, Institute of Medical Science, University of Tokyo, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nagamura-Inoue
authors.affiliation: Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ichinohe
authors.affiliation: 1] Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan [2] Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Department of Hematology, Hokkaido University Graduate School of Medical Science, Sapporo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Teshima
authors.affiliation: Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Murata
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D064591:Allografts; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality*; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D019172:Transplantation Conditioning