title: Immune stimulation during chemotherapy increases incidence of acute graft versus host disease in acute myeloid leukemia: A study on behalf of SFGM-TC and ALFA.
abstract: 60-70% of AML patients have an indication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) during their treatment. Graft versus host disease (GvHD), the major cause of mortality and comorbidities post-transplantation, develops by immunological mechanism and decides greatly prognosis and quality of life (QoL) of graft recipient. Current GvHD prophylaxis is not personalized. Infections, toxicities and leukemic infiltration complicate the first chemotherapy phases prior to allo-HSCT. They, to certain extent, induce local immune stimulation. Impact of immune stimulation of this period on incidence of GvHD has not been evaluated. We retrospectively studied 238 AML patients transplanted at first remission from 21 French centers in the ALFA-0702 protocol and found that cutaneous and digestive immune stimulation during induction increases the incidence of skin and gut aGVHD, respectively. Furthermore, prolonged febrile duration correlates with elevated incidence of grade II-IV aGvHD. Thus, we identified a group of patients with higher risk of aGvHD. The benefit of personalized GvHD prophylaxis should be explored in a prospective cohort to decrease incidence of aGvHD in these patients and improve their QoLs.
authors.affiliation: Saint Louis Hospital, Hematology Department, Paris, France; Shanghai Institute of Hematology, Rui Jin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China; Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France.
authors.forename: Lining
authors.initials: L
authors.lastname: Wang
authors.affiliation: Saint Louis Hospital, Hematology Department, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Raffoux
authors.affiliation: Centre hospitalier Lyon Sud, Hematology Department, Lyon, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Thomas
authors.affiliation: Bone Marrow Transplant Unit, University Hospital, Lille, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.affiliation: Institut Gustave Roussy, Stem Cell Transplantation, Villejuif, France.
authors.forename: Jean-Henri
authors.initials: JH
authors.lastname: Bouhris
authors.affiliation: Institut Gustave Roussy, Hematology Department, Villejuif, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: de Botton
authors.affiliation: Centre hospitalier Lyon Sud, Hematology Department, Lyon, France.
authors.forename: Mauricette
authors.initials: M
authors.lastname: Michallet
authors.affiliation: Pitié-Salpétrière Hospital, Hematology Department, Paris, France.
authors.forename: Stéphanie Nguyen
authors.initials: SN
authors.lastname: Quoc
authors.affiliation: Institut d'Hématologie de Basse-Normandie, Bâtiment Sud Avenue Côte de Nacre, Caen, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Chantepie
authors.affiliation: CHU Besancon, Hematology Department, Besancon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Deconinck
authors.affiliation: CHU Dijon, Hematology Department, Dijon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Caillot
authors.affiliation: CHU Limoges, Hematology Department, Limoges, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Turlure
authors.affiliation: CHU Bordeaux, Haut Leveque Hospital, Hematology Department, Pessac, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Vigouroux
authors.affiliation: CHU Bordeaux, Haut Leveque Hospital, Hematology Department, Pessac, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.affiliation: CHU Toulouse, Hematology Department, Toulouse, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
authors.affiliation: Percy Hospital, Hematology Department, Clamart, France.
authors.forename: Jean-Valère
authors.initials: JV
authors.lastname: Malfuson
authors.affiliation: Centre Henri Becquerel, Hematology Department, Rouen, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Loschi
authors.affiliation: Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Socie
authors.affiliation: Saint Louis Hospital, Hematology Department, Paris, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dombret
authors.affiliation: Saint Louis Hospital, Stem Cell Transplantation Unit, Paris, France.
authors.forename: Régis Peffault
authors.initials: RP
authors.lastname: de la Tour
authors.affiliation: Saint Louis Hospital, Hematology Department, Paris, France; Mediterranean Center of Molecular Medicine, INSERM U1065, Nice, France. Electronic address: cluzeau.thomas@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cluzeau
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D060828:Induction Chemotherapy / Q000009:adverse effects; D007410:Intestinal Diseases / Q000276:immunology; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012871:Skin Diseases / Q000276:immunology; D055815:Young Adult
keywords: AML; GVHD; Infections; Toxicities; Transplantation