Effects of aGVHD and cGVHD on Survival Rate in Patients with Acute Myeloid Leukemia after Allogeneic Stem Cell Transplantation.
BACKGROUND
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) is a curative treatment option for many patients with Acute Myeloid Leukemia (AML); however, it can lead to complications of Graft-Versus-Host-Disease (GVHD) which can affect the quality of life and overall survival. The aim of this study was to assess the effects of both acute and chronic GVHD on survival rate in patients with AML who received HSCT.


METHODS
In a longitudinal study, 587 patients with AML who underwent bone marrow transplantation in Tehran-Iran between1991 and 2011 were recruited. All patient records were analyzed for the occurrence of adverse events including acute and chronic GVHD and leukemia relapse. Data were analyzed using Log-rank, Kaplan-Meier, Univariate and Multivariate Cox Regression models.


RESULTS
The five-year overall survival (OS) was found to be 71.9% (95% CI: 67.40-76.41). Also there was a significant relationship between cGVHD and OS (P=0.001, HR = 0.476, 95%). Hazard of death in these patients was less than those who did not experience an occurrence of cGVHD and aGVHD (HR= 0.629, P= 0.078). A significant relationship between cGVHD and relapse was observed (P< 0.001) indicating that patients who developed cGVHD experienced a better survival rate. A significant relationship was also found between overall survival and aGVHD grade (P< 0.001). Hazard of death (HD) for cGVHD and relapse variables were estimated to be 0.554 and 3.869.


CONCLUSIONS
This study is one of the largest studies (regarding the number of participants) done to date in the Middle East with quite a long duration (20 years). cGVHD appears to have a positive influence on survival rate in patients with AML who received HSCT. It is recommended that further studies investigate the underlying reason or mechanisms behind this.
Department of Epidemiology, Faculty of Public Health, Ilam University of Medical Sciences, Ilam, Iran ; Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran.
Shabnam
S
Shokouhi
Discipline of Medicine, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia ; Department of Hematology/Oncology, Basil Hetzel Institute for Translational Health Research, The Queen Elizabeth Hospital, Woodville, South Australia, Australia.
Sarah
S
Bray
Department of Clinical Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran.
Salar
S
Bakhtiyari
Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran.
Kourosh
K
Sayehmiri
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Kamran
K
Alimoghadam
Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Ardeshir
A
Ghavamzadeh
Acute Myeloid Leukemia; HSCT; Survival rate; aGVHD; cGVHD