Risk Factors for Graft-versus-Host Disease in Haploidentical Hematopoietic Cell Transplantation Using Post-Transplant Cyclophosphamide

被引：35

作者：

Im, Annie ^{[1
]}

Rashidi, Armin ^{[2
]}

Wang, Tao ^{[3
,4
]}

Hemmer, Michael ^{[3
]}

MacMillan, Margaret L. ^{[5
]}

Pidala, Joseph ^{[6
]}

Jagasia, Madan ^{[7
]}

Pavletic, Steven ^{[8
]}

Majhail, Navneet S. ^{[9
]}

Weisdorf, Daniel ^{[2
]}

Abdel-Azim, Hisham ^{[10
]}

Agrawal, Vaibhav ^{[11
]}

Al-Homsi, A. Samer ^{[12
]}

Aljurf, Mahmoud ^{[13
]}

Askar, Medhat ^{[14
]}

Auletta, Jeffery J. ^{[15
,16
,17
,18
,19
]}

Bashey, Asad ^{[20
]}

Beitinjaneh, Amer ^{[21
]}

Bhatt, Vijaya Raj ^{[22
]}

Byrne, Michael ^{[7
]}

Cahn, Jean-Yves ^{[23
]}

Cairo, Mitchell ^{[24
]}

Castillo, Paul ^{[25
]}

Cerny, Jan ^{[26
]}

Chhabra, Saurabh ^{[3
]}

Choe, Hannah ^{[27
]}

Ciurea, Stefan ^{[28
]}

Daly, Andrew ^{[29
]}

Diaz Perez, Miguel Angel ^{[30
]}

Farhadfar, Nosha ^{[31
]}

Gadalla, Shahinaz M. ^{[32
]}

Gale, Robert ^{[33
]}

Ganguly, Siddhartha ^{[34
]}

Gergis, Usama ^{[35
]}

Hanna, Rabi ^{[36
]}

Hematti, Peiman ^{[37
]}

Herzig, Roger ^{[38
]}

Hildebrandt, Gerhard C. ^{[39
]}

Lad, Deepesh P. ^{[40
]}

Lee, Catherine ^{[41
]}

Lehmann, Leslie ^{[42
]}

Lekakis, Lazaros ^{[21
]}

Kamble, Rammurti T. ^{[43
]}

Kharfan-Dabaja, Mohamed A. ^{[44
]}

Khandelwal, Pooja ^{[45
,46
]}

Martino, Rodrigo ^{[47
]}

Murthy, Hemant S. ^{[44
]}

Nishihori, Taiga ^{[48
]}

O'Brien, Tracey A. ^{[49
]}

Olsson, Richard F. ^{[50
,51
]}

机构：

[1] Univ Pittsburgh, UPMC, Hillman Canc Ctr, Pittsburgh, PA USA

[2] Univ Minnesota, Dept Med, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA

[3] Med Coll Wisconsin, Dept Med, CIBMTR, Milwaukee, WI 53226 USA

[4] Med Coll Wisconsin, Inst Hlth & Equ, Div Biostat, Milwaukee, WI 53226 USA

[5] Univ Minnesota, Dept Pediat, Blood & Marrow Transplant Program, Minneapolis, MN 55455 USA

[6] H Lee Moffitt Canc Ctr & Res Inst, Tampa, FL USA

[7] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[8] NCI, Immune Deficiency Cellular Therapy Program, Ctr Canc Res, Bethesda, MD 20892 USA

[9] Cleveland Clin, Taussig Canc Inst, Blood & Marrow Transplant Program, 9500 Euclid Ave,CA 60, Cleveland, OH 44195 USA

[10] Univ Southern Calif, Div Hematol Oncol & Blood & Marrow Transplantat, Childrens Hosp Los Angeles, Keck Sch Med, Los Angeles, CA 90007 USA

[11] Indiana Univ Sch Med, Div Hematol Oncol, Indianapolis, IN 46202 USA

[12] NYU, Langone Med Ctr, New York, NY USA

[13] King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia

[14] Baylor Univ, Med Ctr, Dept Pathol & Lab Med, Dallas, TX USA

[15] Nationwide Childrens Hosp, Blood & Marrow Transplant Program, Columbus, OH USA

[16] Nationwide Childrens Hosp, Host Def Program, Div Hematol, Columbus, OH USA

[17] Nationwide Childrens Hosp, Div Oncol, Host Def Program, Columbus, OH USA

[18] Nationwide Childrens Hosp, Div Bone Marrow Transplant, Host Def Program, Columbus, OH USA

[19] Nationwide Childrens Hosp, Div Infect Dis, Host Def Program, Columbus, OH USA

[20] Northside Hosp, Blood & Marrow Transplant Program, Atlanta, GA USA

[21] Univ Miami, Dept Hematol & Oncol, Miami, FL USA

[22] Univ Nebraska Med Ctr, Fred & Pamela Buffett Canc Ctr, Omaha, NE USA

[23] CHU Grenoble Alpes, Dept Hematol, Grenoble, France

[24] New York Med Coll, Dept Pediat, Div Pediat Hematol Oncol & Stem Cell Transplantat, Valhalla, NY 10595 USA

[25] UF Hlth Shands Childrens Hosp, Gainesville, FL USA

[26] Univ Massachusetts, Med Ctr, Dept Med, Div Hematol Oncol, Worcester, MA USA

[27] Ohio State Univ, Wexner Med Ctr, James Comprehens Canc Ctr, Columbus, OH 43210 USA

[28] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA

[29] Tom Baker Canc Clin, Calgary, AB, Canada

[30] Hosp Infantil Univ Nino Jesus, Dept Hematol Oncol, Madrid, Spain

[31] Univ Florida, Coll Med, Div Hematol Oncol, Gainesville, FL USA

[32] NCI, Div Canc Epidemiol & Genet, NIH, Clin Genet Branch, Rockville, MD USA

[33] Imperial Coll London, Hematol Res Ctr, Dept Med, Div Expt Med, London, England

[34] Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA

[35] Thomas Jefferson Univ, Dept Med Oncol, Philadelphia, PA USA

[36] Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA

[37] Univ Wisconsin, Dept Med, Div Hematol Oncol Bone Marrow Transplantat, Madison, WI USA

[38] Univ Kentucky, Chandler Med Ctr, Louisville, KY USA

[39] Univ Kentucky, Markey Canc Ctr, Lexington, KY USA

[40] Postgrad Inst Med Educ & Res, Dept Internal Med, Chandigarh, India

[41] Univ Utah, Huntsman Canc Inst, Utah Blood & Marrow Transplant Program, Salt Lake City, UT USA

[42] Boston Childrens Hosp, Dana Farber Canc Inst, Boston, MA USA

[43] Baylor Coll Med, Ctr Cell & Gene Therapy, Div Hematol & Oncol, Houston, TX 77030 USA

[44] Mayo Clin, Div Hematol Oncol, Blood & Marrow Transplantat Program, Jacksonville, FL USA

[45] Cincinnati Childrens Hosp Med Ctr, Div Bone Marrow Transplant & Immune Deficiency, Cincinnati, OH 45229 USA

[46] Univ Cincinnati, Dept Pediat, Cincinnati, OH USA

[47] Hosp Santa Creu & Sant Pau, Div Clin Hematol, Barcelona, Spain

[48] H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplant & Cellular Immunot, Tampa, FL USA

[49] Sydney Childrens Hosp, Kids Canc Ctr, Blood & Marrow Transplant Program, Sydney, NSW, Australia

[50] Karolinska Inst, Dept Lab Med, Stockholm, Sweden

来源：

BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION | 2020年 / 26卷 / 08期

基金：

美国国家卫生研究院;

关键词：

BLOOD STEM-CELLS; BONE-MARROW-TRANSPLANTATION; ACUTE MYELOID-LEUKEMIA; RELAPSE-FREE SURVIVAL; PERIPHERAL-BLOOD; HEMATOLOGIC MALIGNANCIES; DONOR TRANSPLANTATION; CONDITIONING REGIMEN; ACUTE GVHD; OUTCOMES;

D O I：

10.1016/j.bbmt.2020.05.001

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Post-transplant cyclophosphamide (PTCy) has significantly increased the successful use of haploidentical donors with a relatively low incidence of graft-versus-host disease (GVHD). Given its increasing use, we sought to determine risk factors for GVHD after haploidentical hematopoietic cell transplantation (haplo-HCT) using PTCy. Data from the Center for International Blood and Marrow Transplant Research on adult patients with acute myeloid leukemia, acute lymphoblastic leukemia, myelodysplastic syndrome, or chronic myeloid leukemia who underwent PTCy-based haplo-HCT (2013 to 2016) were analyzed and categorized into 4 groups based on myeloablative (MA) or reduced-intensity conditioning (RIC) and bone marrow (BM) or peripheral blood (PB) graft source. In total, 646 patients were identified (MA-BM = 79, MA-PB = 183, RIC-BM = 192, RIC-PB = 192). The incidence of grade 2 to 4 acute GVHD at 6 months was highest in MA-PB (44%), followed by RIC-PB (36%), MA-BM (36%), and RIC-BM (30%) (P = .002). The incidence of chronic GVHD at 1 year was 40%, 34%, 24%, and 20%, respectively (P < .001). In multivariable analysis, there was no impact of stem cell source or conditioning regimen on grade 2 to 4 acute GVHD; however, older donor age (30 to 49 versus <29 years) was significantly associated with higher rates of grade 2 to 4 acute GVHD (hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.11 to 2.12; P = .01). In contrast, PB compared to BM as a stem cell source was a significant risk factor for the development of chronic GVHD (HR, 1.70; 95% CI, 1.11 to 2.62; P = .01) in the RIC setting. There were no differences in relapse or overall survival between groups. Donor age and graft source are risk factors for acute and chronic GVHD, respectively, after PTCy-based haplo-HCT. Our results indicate that in RIC haplo-HCT, the risk of chronic GVHD is higher with PB stem cells, without any difference in relapse or overall survival. (C) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

引用

页码：1459 / 1468

页数：10

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