Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study

Hidehiro Itonaga, Masako Iwanaga, Kazunari Aoki, Jun Aoki, Ken Ishiyama, Takayuki Ishikawa, Toru Sakura, Takahiro Fukuda, Yuho Najima, Toshiaki Yujiri, Takehiko Mori, Mineo Kurokawa, Yuichiro Nawa, Naoyuki Uchida, Yoshihisa Morishita, Hisako Hashimoto, Tetsuya Eto, Makoto Hirokawa, Yasuo Morishima, Tokiko Nagamura-InoueYoshiko Atsuta, Yasushi Miyazaki

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a therapeutic option that may lead to improved outcomes in patients with chronic myelomonocytic leukemia (CMML). However, few studies have examined the impact of the grade of graft-versus-host disease (GVHD) on post-transplant outcomes for CMML. We retrospectively analyzed the outcomes of 141 patients with CMML who underwent allo-HSCT between 1987 and 2010, and achieved neutrophil engraftment. The effects of acute GVHD (aGVHD) or chronic GVHD (cGVHD) on overall survival (OS), leukemia-associated mortality (LAM), and transplant-related mortality were evaluated by hazards regression models, in which the onset date of aGVHD or cGVHD was treated as a time-dependent covariate. Grade I aGVHD was associated with better OS and lower LAM (P = 0.042, P = 0.033, respectively) than no GVHD in univariate analyses, but not in the multivariate analyses. The multivariate analyses demonstrated that extensive cGVHD significantly associated with better OS (Hazard Ratio [HR] 0.35 [95% confidence intervals (CI), 0.16-0.74]; P = 0.007) and lower LAM (HR 0.36 [95% CI, 0.14-0.92]; P = 0.033) in patients who were not in complete remission at transplantation. In conclusion, the occurrence of cGVHD may be an important factor affecting the outcomes of CMML patients who received transplantation.

Original languageEnglish
Pages (from-to)48-55
Number of pages8
JournalLeukemia Research
Volume41
DOIs
Publication statusPublished - 2016 Feb 1

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Chronic myelomonocytic leukemia
  • Graft-versus-host disease
  • Graft-versus-leukemia effect

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Cancer Research

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    Itonaga, H., Iwanaga, M., Aoki, K., Aoki, J., Ishiyama, K., Ishikawa, T., Sakura, T., Fukuda, T., Najima, Y., Yujiri, T., Mori, T., Kurokawa, M., Nawa, Y., Uchida, N., Morishita, Y., Hashimoto, H., Eto, T., Hirokawa, M., Morishima, Y., ... Miyazaki, Y. (2016). Impacts of graft-versus-host disease on outcomes after allogeneic hematopoietic stem cell transplantation for chronic myelomonocytic leukemia: A nationwide retrospective study. Leukemia Research, 41, 48-55. https://doi.org/10.1016/j.leukres.2015.12.009