Acute and Chronic Graft-Versus-Host Disease After Allogeneic Peripheral-Blood Stem-Cell and Bone Marrow Transplantation: A Meta-Analysis

Cutler, Corey; Giri, Satyendra; Jeyapalan, Suriya; Paniagua, David; Viswanathan, Akila; Antin, Joseph H.

doi:10.1200/jco.2001.19.16.3685

Cited by 392 publications

(265 citation statements)

References 30 publications

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“…Several reports have shown that the use of peripheral blood as a source of haematopoietic stem cells increased the incidence of chronic GVHD (Cutler et al, 2001;Przepiorka et al, 2001;Flowers et al, 2002). However, stem cell source did not influence GSS or the duration of systemic IST in our study.…”

Section: Discussioncontrasting

confidence: 71%

Graft‐versus‐host disease (GVHD)‐specific survival and duration of systemic immunosuppressive treatment in patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation

Lee

Choi

et al. 2003

Br J Haematol

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Summary. We investigated graft-versus-host disease (GVHD)-specific survival (GSS) and the duration of systemic immunosuppressive treatment (IST) in 82 patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation (HCT). These two major study endpoints were calculated using the Kaplan-Meier method. Deaths solely due to the relapse of underlying disease or accidental deaths were censored at the time of occurrence for the analysis of GSS. The probability of GSS at 5 years was 74AE2%. The median duration of systemic IST for chronic GVHD was 272 d (range: 7-1450), and the probability of withdrawal of systemic IST at 1, 2 and 3 years was 67AE3%, 82AE4% and 89AE0% respectively. Analysis based on a multivariate model showed that a diagnosis other than leukaemia or myelodysplastic syndrome (P ¼ 0AE049), prior occurrence of grade III-IV acute GVHD (P ¼ 0AE021), onset of chronic GVHD before d 120 (P ¼ 0AE013), serum alkaline phosphatase over 120 IU/l (P ¼ 0AE034), and serum bilirubin over 34AE2 lmol/l (P ¼ 0AE015) were independent adverse prognostic factors for GSS. Prior occurrence of grade III-IV acute GVHD significantly influenced the duration of systemic IST (P ¼ 0AE048). In conclusion, analyses of GSS and the duration of systemic IST will allow patients with different outcomes to be stratified for appropriate treatment application and will provide important parameters in prospective trials for the treatment of chronic GVHD.

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Section: Discussioncontrasting

confidence: 71%

Graft‐versus‐host disease (GVHD)‐specific survival and duration of systemic immunosuppressive treatment in patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation

Lee

Choi

et al. 2003

Br J Haematol

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“…The incidence of chronic GvHD was higher than that in our previous experience (56%) [32] or in other reports [31,33] even after considering inevitable differences in the ethnicity, GvHD prophylaxis and matching practice of HLA, or disease risk. G-CSF mobilized peripheral blood stem cells may have been associated with an increased incidence of GvHD, particularly in its chronic form [34,35]. Conditioning regimen excluded antithymocyte globulin was also a possible explanation of this finding [23].…”

Section: Discussionmentioning

confidence: 96%

Prospective phase II trial to evaluate the complications and kinetics of chimerism induction following allogeneic hematopoietic stem cell transplantation with fludarabine and busulfan

Saito

Kami

Mori³

et al. 2007

American J Hematol

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This prospective trial assessed the safety and efficacy of allogeneic hematopoietic stem cell transplantation from a HLA-matched donor with a reduced-intensity regimen (RIST) consisting of iv fludarabine 30 mg/m 2 for 6 days and oral busulfan 4 mg/kg/day for 2 days in patients older than 50 years with hematological malignancies. Cyclosporine alone or cyclosporine with short-term methotrexate was randomized for graftversus-host disease prophylaxis. After 30 patients had been enrolled, an interim analysis was performed, and this report focuses on a precise evaluation of the toxicity profile and chimerism kinetics. Sustained engraftment in all patients, no severe regimen-related toxicity (RRT) within 20 days, and no transplantrelated mortality through Day 100 were observed. T-cell (CD3+) full-donor (over 90%) chimerism was observed in 22 of the 30 patients, while the remaining eight had mixed-donor chimerism over 77% on Day 90. Thereafter, five subsequently converted to full-donor chimerism without donor lymphocyte infusion by day 120 (n = 4) or Day 180 (n = 1). Two showed persistent mixed chimerism without relapse through Day 180. Grade III-IV acute graft-versus-host disease and extensive chronic graft-versus-host disease occurred in 10% and 73%, respectively. With a median follow-up of 1.5 years, overall survival and disease-free survival at 1 year was 83% and 62%, respectively. Seven patients hematologically relapsed overall, and five of them had myelodysplastic syndrome with poor prognostic factors. In older patients, RIST with fludarabine and busulfan was associated with acceptable toxicities and a satisfactory antileukemia effect, regardless of the early chimerism status. Am. J. Hematol. 82:873-880, 2007. V

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“…[20][21][22] However, administration of rhG-CSF leads to high serum levels in individuals, exceeding endogenous G-CSF levels measured under physiological and pathophysiological conditions, leading to adverse events in a number of them. 7 In contrast to BM, which is collected under general anesthesia by multiple aspirates from the iliac crest, a good peripheral venous access is a requirement for successful PBPC collection.…”

Section: Discussionmentioning

confidence: 99%

Regeneration, health status and quality of life after rhG-CSF-stimulated stem cell collection in healthy donors: a cross-sectional study

Leitner

Baumgartner

Kalhs

et al. 2008

Bone Marrow Transplant

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Mobilized allogeneic PBPC are increasingly used instead of BM for allogeneic stem cell grafting. Although the short-term safety profile of recombinant human (rh)G-CSF seems acceptable, only minimal data on long-term safety are available. We therefore reviewed data on 171 sibling donors (M/F: 98/73) with respect to side effects of rhG-CSF and PBPC collection and impact on quality of life (QoL) and health status. In a cross-sectional study, we investigated the actual QoL and health status of the donors as well as the need for medical treatment since PBPC donation by a questionnaire that was sent to 151 donors. Ninety-five (64%) of the addressed donors responded to the questionnaire, but only 69 (46%) of them reported on their actual health status and QoL, which was good to very good in the majority of them. Two donors developed malignancies in the post-donation course. In general, PBPC collection after rhG-CSF mobilization was well tolerated by the responding donors. Although the reported events in medical history after PBPC donation do not seem to be associated with rhG-CSF administration or the collection procedure, a lifelong follow-up of donors should be obligatory.

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Acute and Chronic Graft-Versus-Host Disease After Allogeneic Peripheral-Blood Stem-Cell and Bone Marrow Transplantation: A Meta-Analysis

Abstract: Both acute and chronic GVHD are more common after PBSCT than BMT, and this may be associated with lower rates of malignant relapse. The magnitude of the transfused T-cell load may explain the differences in chronic GVHD risk.

Cited by 392 publications

References 30 publications

Graft‐versus‐host disease (GVHD)‐specific survival and duration of systemic immunosuppressive treatment in patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation

Graft‐versus‐host disease (GVHD)‐specific survival and duration of systemic immunosuppressive treatment in patients who developed chronic GVHD following allogeneic haematopoietic cell transplantation

Prospective phase II trial to evaluate the complications and kinetics of chimerism induction following allogeneic hematopoietic stem cell transplantation with fludarabine and busulfan

Regeneration, health status and quality of life after rhG-CSF-stimulated stem cell collection in healthy donors: a cross-sectional study

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