Effect of graft-versus-host disease on the outcome of bone marrow transplantation from an HLA-identical sibling donor using GVHD prophylaxis with cyclosporin A and methotrexate

Y. Kanda, K. Izutsu, H. Hirai, H. Sakamaki, T. Iseki, Y. Kodera, S. Okamoto, H. Mitsui, K. Iwato, N. Hirabayashi, T. Furukawa, A. Maruta, M. Kasai, Y. Atsuta, N. Hamajima, A. Hiraoka, K. Kawa

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Abstract

The effect of graft-versus-host disease (GVHD) on relapse incidence and survival has been analyzed in several studies, but previous studies included heterogeneous patients. Therefore, we analyzed the data of 2114 patients who received unmanipulated bone marrow graft from an HLA-identical sibling donor with a GVHD prophylaxis using cyclosporin A and methotrexate. Among the 1843 patients who survived without relapse at 60 days after transplantation, 435 (24%) developed grade II-IV acute GVHD. Among the 1566 patients who survived without relapse at 150 days after transplantation, 705 (47%) developed chronic GVHD. The incidence of relapse was significantly lower in patients who developed acute or chronic GVHD, but disease-free survival (DFS) was significantly inferior in patients who developed acute GVHD. A benefit of 'mild' GVHD was only seen in high-risk patients who developed grade I acute GVHD. The strongest association between GVHD and a decreased incidence of relapse was observed in patients with standard-risk acute myelogenous leukemia/myelodysplastic syndrome. In conclusion, the therapeutic window between decreased relapse and increased transplant-related mortality due to the development of GVHD appeared to be very narrow.

Original languageEnglish
Pages (from-to)1013-1019
Number of pages7
JournalLeukemia
Volume18
Issue number5
DOIs
Publication statusPublished - 2004 May

Keywords

  • Bone marrow transplantation
  • Graft-versus-host disease
  • Graft-versus-leukemia effect

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Kanda, Y., Izutsu, K., Hirai, H., Sakamaki, H., Iseki, T., Kodera, Y., Okamoto, S., Mitsui, H., Iwato, K., Hirabayashi, N., Furukawa, T., Maruta, A., Kasai, M., Atsuta, Y., Hamajima, N., Hiraoka, A., & Kawa, K. (2004). Effect of graft-versus-host disease on the outcome of bone marrow transplantation from an HLA-identical sibling donor using GVHD prophylaxis with cyclosporin A and methotrexate. Leukemia, 18(5), 1013-1019. https://doi.org/10.1038/sj.leu.2403343