TY - JOUR
T1 - Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation
AU - Nakasone, H.
AU - Fukuda, T.
AU - Kanda, J.
AU - Mori, T.
AU - Yano, S.
AU - Kobayashi, T.
AU - Miyamura, K.
AU - Eto, T.
AU - Kanamori, H.
AU - Iwato, K.
AU - Uchida, N.
AU - Mori, S.
AU - Nagamura-Inoue, T.
AU - Ichinohe, T.
AU - Atsuta, Y.
AU - Teshima, T.
AU - Murata, M.
N1 - Funding Information:
We express our appreciation for the work of all the physicians and data managers at the centers who contributed valuable data on transplantation to the Japan Society for Hematopoietic Cell Transplantation (JSHCT), the Japan Marrow Donor Program (JMDP) and the Japan Cord Blood Bank Network (JCBBN). We also thank all of the members of the Transplant Registry Unified Management committees at JSHCT, JMDP and JCBBN for their dedicated data management. This work was supported in part by a Research Grant for Allergic Disease and Immunology from the Japanese Ministry of Health, Labor and Welfare (YA).
Publisher Copyright:
© 2015 Macmillan Publishers Limited.
PY - 2015/4/4
Y1 - 2015/4/4
N2 - The impact of the conditioning intensity and TBI on acute GVHD (aGVHD) is still a matter of debate. We analyzed 6848 adult recipients who received allogeneic hematopoietic cell transplants (HCT) between 2006 and 2011 in Japan. The subjects were divided into groups who had received myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC), either with or without TBI. There was a significant difference in the incidence of aGVHD 2-4 among the different conditioning types: 39% in TBI-MAC, 35% in TBI-RIC and 32% in both no-TBI MAC and no-TBI-RIC (P<0.001). In a multivariate analysis, TBI-MAC, but not no-TBI MAC, was significantly associated with an increased risk of aGVHD 2-4 (hazard ratio (HR) 1.33, P<0.01), whereas TBI-RIC was associated with an increased risk of GVHD 3-4 (HR 1.36, P=0.048). TBI-MAC and TBI-RIC were significantly associated with skin and gastrointestinal aGVHD. Subgroup analyses demonstrated that not only TBI-MAC, but also TBI-RIC, was significantly associated with aGVHD 2-4 in older patients. Furthermore, high-dose TBI only had an adverse impact on aGVHD 2-4 in HLA-matched HCT. Impacts of intensity and TBI on aGVHD differ by patient backgrounds, and this difference should be considered to establish a risk-adapted strategy for the prevention of aGVHD.
AB - The impact of the conditioning intensity and TBI on acute GVHD (aGVHD) is still a matter of debate. We analyzed 6848 adult recipients who received allogeneic hematopoietic cell transplants (HCT) between 2006 and 2011 in Japan. The subjects were divided into groups who had received myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC), either with or without TBI. There was a significant difference in the incidence of aGVHD 2-4 among the different conditioning types: 39% in TBI-MAC, 35% in TBI-RIC and 32% in both no-TBI MAC and no-TBI-RIC (P<0.001). In a multivariate analysis, TBI-MAC, but not no-TBI MAC, was significantly associated with an increased risk of aGVHD 2-4 (hazard ratio (HR) 1.33, P<0.01), whereas TBI-RIC was associated with an increased risk of GVHD 3-4 (HR 1.36, P=0.048). TBI-MAC and TBI-RIC were significantly associated with skin and gastrointestinal aGVHD. Subgroup analyses demonstrated that not only TBI-MAC, but also TBI-RIC, was significantly associated with aGVHD 2-4 in older patients. Furthermore, high-dose TBI only had an adverse impact on aGVHD 2-4 in HLA-matched HCT. Impacts of intensity and TBI on aGVHD differ by patient backgrounds, and this difference should be considered to establish a risk-adapted strategy for the prevention of aGVHD.
UR - http://www.scopus.com/inward/record.url?scp=84926408530&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84926408530&partnerID=8YFLogxK
U2 - 10.1038/bmt.2014.293
DO - 10.1038/bmt.2014.293
M3 - Article
C2 - 25531281
AN - SCOPUS:84926408530
SN - 0268-3369
VL - 50
SP - 559
EP - 565
JO - Bone Marrow Transplantation
JF - Bone Marrow Transplantation
IS - 4
ER -