title: Graft-Versus-Host Disease in Adolescents and Young Adults (15-24 Years Old) After Allogeneic Hematopoietic Stem Cell Transplantation for Acute Leukemia in First Complete Remission.
abstract: OBJECTIVE
  Adolescents and young adults (AYAs) with cancer are a unique group of patients in terms of disease incidence and biology, outcome, and psychosocial needs. This study aims to correlate the risk of graft-versus-host disease (GvHD) and age in a population of children and young adults with acute leukemia undergoing hematopoietic stem cell transplantation (HSCT) in first complete remission (CR).
  
  
  METHODS
  We analyzed the outcome of 153 consecutive children (<15 years), AYAs (15-24 years), and adults (25-35 years) with lymphoblastic or myeloid acute leukemia in first CR who underwent HSCT with matched donors after myeloablative conditioning. GvHD prophylaxis was methotrexate and cyclosporine A (CsA) in all patients.
  
  
  RESULTS
  The cumulative incidence of grade II-IV acute GvHD (aGvHD) was significantly higher in AYA patients than in children (subdistribution hazard ratio (SHR), 2.04, p = 0.005) or adults (SHR 1.59, p = 0.048). Both gut and skin aGvHD occurred more frequently in AYA patients. Increasing CsA blood levels with age could not fully account for this difference. No difference in terms of grade III-IV aGvHD was observed. Chronic GvHD was more frequent in AYAs (SHR 2.81, p = 0.007) and adults (SHR 2.31, p = 0.033) than in children. No difference in terms of nonrelated mortality and overall survival was observed among the age subgroups.
  
  
  CONCLUSIONS
  Since GvHD occurrence is strongly correlated to quality of life, specific attention should be paid to AYAs undergoing HSCT. Further studies should investigate the reasons for the excess of GvHD observed in this population.
authors.affiliation: 1 Unité d'Hématologie-Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Marguerite
authors.initials: M
authors.lastname: Vignon
authors.affiliation: 1 Unité d'Hématologie-Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Annalisa
authors.initials: A
authors.lastname: Andreoli
authors.affiliation: 1 Unité d'Hématologie-Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dhédin
authors.affiliation: 1 Unité d'Hématologie-Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Etienne
authors.initials: E
authors.lastname: Lengliné
authors.affiliation: 2 Laboratoire d'Histocompatibilité, Hôpital Saint-Louis , Paris, France .
authors.forename: Emeline
authors.initials: E
authors.lastname: Masson
authors.affiliation: 3 Service d'Hématologie-Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: 2 Laboratoire d'Histocompatibilité, Hôpital Saint-Louis , Paris, France .
authors.forename: Clémence
authors.initials: C
authors.lastname: Granier
authors.affiliation: 4 Unité de Thérapie Cellulaire, Centre d'Investigation Clinique en Biothérapies CIC-BT501 , Hôpital Saint-Louis, Paris, France .
authors.forename: Jérôme
authors.initials: J
authors.lastname: Larghero
authors.affiliation: 5 Service de Médecine Nucléaire , Hôpital Saint-Louis, Paris, France .
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Schlageter
authors.affiliation: 3 Service d'Hématologie-Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Régis Peffault
authors.initials: RP
authors.lastname: de Latour
authors.affiliation: 3 Service d'Hématologie-Greffe, INSERM U940, Hôpital Saint-Louis, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.affiliation: 1 Unité d'Hématologie-Adolescents et Jeunes Adultes, Hôpital Saint-Louis, EA-3518, Université Paris 7 Denis Diderot , Paris, France .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boissel
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D016572:Cyclosporine / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007410:Intestinal Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008727:Methotrexate / Q000627:therapeutic use; D009026:Mortality; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D016016:Proportional Hazards Models; D011788:Quality of Life; D012074:Remission Induction; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015996:Survival Rate; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D008727:Methotrexate
keywords: acute lymphoblastic leukemia; acute myeloid leukemia; allogeneic stem cell transplantation; graft-versus-host disease