Comparison of graft-versus-host disease-free, relapse-free survival according to a variety of graft sources: antithymocyte globulin and single cord blood provide favorable outcomes in some subgroups.
Graft-versus-host disease-free relapse-free survival, which is defined as the absence of grade III-IV acute graft-versus-host disease, systemically treated chronic graft-versus-host disease, relapse, and death, is a novel, meaningful composite end point for clinical trials. To characterize risk factors and differences in graft-versus-host disease-free relapse-free survival according to a variety of graft sources, we analyzed 23,302 patients with hematologic malignancy that had a first allogeneic transplantation from 2000 through 2013 using the Japanese national transplant registry database. The 1-year graft-versus-host disease-free relapse-free survival rate was 41% in all patients. The rate was higher after bone marrow transplantation than after peripheral blood stem cell transplantation due to the lower risks of III-IV acute and chronic graft-versus-host disease. The rate was highest after HLA-matched sibling bone marrow transplantation. The rate after single cord blood transplantation was comparable to that after HLA-matched unrelated bone marrow transplantation among patients aged 20 years or under, and was comparable or better than other alternative graft sources among patients aged 21 years or over, due to the low risk of chronic graft-versus-host disease. Other factors associated with better graft-versus-host disease-free relapse-free survival include female patients, antithymocyte globulin prophylaxis (for standard-risk disease), recent years of transplantation, sex combinations other than from a female donor to a male patient, the absence of prior autologous transplantation, myeloablative conditioning, negative cytomegalovirus serostatus, and tacrolimus-based prophylaxis. These results provide important information to guide the choice of graft sources and are benchmarks for future graft-versus-host disease prophylaxis studies.
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan yinamoto@ncc.go.jp.
Yoshihiro
Y
Inamoto
Division of Hematology, National Defense Medical College, Tokorozawa, Japan.
Fumihiko
F
Kimura
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Junya
J
Kanda
Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Junichi
J
Sugita
Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Kazuhiro
K
Ikegame
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Hideki
H
Nakasone
Department of Hematology, Gifu University Hospital, Tokyo, Japan.
Yasuhito
Y
Nannya
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Naoyuki
N
Uchida
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
Takahiro
T
Fukuda
Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Fukuoka, Japan.
Kosuke
K
Yoshioka
Department of Hematology, Japanese Red Cross Nagoya First Hospital, Fukuoka, Japan.
Yukiyasu
Y
Ozawa
Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
Ichiro
I
Kawano
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan.|Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.
Yoshiko
Y
Atsuta
Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Japan.
Koji
K
Kato
Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan.
Tatsuo
T
Ichinohe
Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan.
Masami
M
Inoue
Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Takanori
T
Teshima
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
D000961:Antilymphocyte Serum
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