Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-12-22

AUTHORS

H Nakasone, T Fukuda, J Kanda, T Mori, S Yano, T Kobayashi, K Miyamura, T Eto, H Kanamori, K Iwato, N Uchida, S Mori, T Nagamura-Inoue, T Ichinohe, Y Atsuta, T Teshima, M Murata

ABSTRACT

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. More... »

PAGES

559-565

Journal

TITLE

Bone Marrow Transplantation

ISSUE

4

VOLUME

50

Author Affiliations

  • Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
  • Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
  • Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
  • Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
  • Hematology Division, Tokyo Metropolitan Cancer & Infectious Disease Center, Komagome Hospital, Tokyo, Japan
  • Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
  • Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
  • Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
  • Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors, Hiroshima, Japan
  • Department of Hematology, Toranomon Hospital, Tokyo, Japan
  • Division of Hematology and Oncology, St Luke’s International Hospital, Tokyo, Japan
  • Department of Cell Processing and Transfusion, Institute of Medical Science, University of Tokyo, Tokyo, Japan
  • Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
  • Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Department of Hematology, Hokkaido University Graduate School of Medical Science, Sapporo, Japan
  • Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1038/bmt.2014.293

    DOI

    http://dx.doi.org/10.1038/bmt.2014.293

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1000915822

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25531281


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    22 schema:description 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.
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