| Literature DB >> 29155316 |
Muna Qayed1, Tao Wang2, Michael T Hemmer3, Stephen Spellman4, Mukta Arora5, Daniel Couriel6, Amin Alousi7, Joseph Pidala8, Hisham Abdel-Azim9, Mahmoud Aljurf10, Mouhab Ayas11, Menachem Bitan12, Mitchell Cairo13, Sung Won Choi14, Christopher Dandoy15, David Delgado16, Robert Peter Gale17, Gregory Hale18, Haydar Frangoul19, Rammurti T Kamble20, Mohamed Kharfan-Dabaja8, Leslie Lehman21, John Levine22, Margaret MacMillan5, David I Marks23, Taiga Nishihori8, Richard F Olsson24, Peiman Hematti25, Olov Ringden26, Ayman Saad27, Prakash Satwani28, Bipin N Savani29, Kirk R Schultz30, Sachiko Seo31, Shalini Shenoy32, Edmund K Waller33, Lolie Yu34, Mary M Horowitz3, John Horan35.
Abstract
Relapse remains the major cause of mortality after hematopoietic cell transplantation (HCT) for pediatric acute leukemia. Previous research has suggested that reducing the intensity of calcineurin inhibitor-based graft-versus-host disease (GVHD) prophylaxis may be an effective strategy for abrogating the risk of relapse in pediatric patients undergoing matched sibling donor (MSD) HCT. We reasoned that the benefits of this strategy could be maximized by selectively applying it to those patients least likely to develop GVHD. We conducted a study of risk factors for GVHD, to risk-stratify patients based on age. Patients age <18 years with leukemia who received myeloablative, T cell-replete MSD bone marrow transplantation and calcineurin inhibitor-based GVHD prophylaxis between 2000 and 2013 and were entered into the Center for International Blood and Marrow Transplant Research registry were included. The cumulative incidence of grade II-IV acute GVHD (aGVHD) was 19%, that of grade II-IV aGVHD 7%, and that of chronic GVHD (cGVHD) was 16%. Compared with age 13 to 18 years, age 2 to 12 years was associated with a lower risk of grade II-IV aGVHD (hazard ratio [HR], .42; 95% confidence interval [CI], .26 to .70; P = .0008), grade II-IV aGVHD (HR, .24; 95% CI, .10 to .56; P = .001), and cGVHD (HR, .32; 95% CI, .19 to .54; P < .001). Compared with 2000-2004, the risk of grade II-IV aGVHD was lower in children undergoing transplantation in 2005-2008 (HR, .36; 95% CI, .20 to .65; P = .0007) and in 2009-2013 (HR, .24; 95% CI. .11 to .53; P = .0004). Similarly, the risk of grade III-IV aGVHD was lower in children undergoing transplantation in 2005-2008 (HR, .23; 95% CI, .08 to .65; P = .0056) and 2009-2013 (HR, .16; 95% CI, .04 to .67; P = .0126) compared with those doing so in 2000-2004. We conclude that aGVHD rates have decreased significantly over time, and that children age 2 to 12 years are at very low risk for aGVHD and cGVHD. These results should be validated in an independent analysis, because these patients with high-risk malignancies may be good candidates for trials of reduced GVHD prophylaxis.Entities:
Keywords: Children; GVHD; Leukemia; Matched sibling donor transplantation; Recipient age
Mesh：
Substances：
Year: 2017 PMID： 29155316 PMCID： PMC5826854 DOI： 10.1016/j.bbmt.2017.11.004
Source DB: PubMed Journal: Biol Blood Marrow Transplant ISSN： 1083-8791 Impact factor: 5.742