Graft-versus-Host Disease after HLA-Matched Sibling Bone Marrow or Peripheral Blood Stem Cell Transplantation: Comparison of North American Caucasian and Japanese Populations

Abstract

The risk of acute graft-versus-host disease (GVHD) after HLA-matched sibling bone marrow (BM) transplantation is lower in Japanese than in Caucasian patients. However, race may have differential effect on GVHD dependent on the graft source. North American Caucasian and Japanese patients receiving their first allogeneic BM or peripheral blood stem cell (PBSC) transplantations from an HLA-matched sibling for leukemia were eligible. BM was used in 13% and 53% of Caucasian and Japanese patients, respectively. In multivariate analysis, the interaction term between race and graft source was not significant in any of the models, indicating that graft source does not affect the impact of race on outcomes. The risk of grades III–IV acute GVHD was significantly lower in Japanese than in Caucasian patients (hazard ratio (HR) 0.74, 95% confidence interval (CI) 0.57–0.96), which resulted in lower risk of non-relapse mortality in Japanese patients (HR 0.69, 95% CI 0.54–0.89). The risk of relapse was also lower in this group. Lower risk of non-relapse mortality and relapse resulted in lower overall mortality rates among Japanese patients. In conclusion, irrespective of graft source, the risk of severe acute GVHD is lower in Japanese patients, which results in lower risk of non-relapse mortality.

Comparison of graft-versus-host disease-free, relapse-free survival according to a variety of graft sources: antithymocyte globulin and single cord blood provide favorable outcomes in some subgroups

“…14 These differences may reflect the lower incidence of severe GvHD in the Japanese population derived from genetic homogeneity than in the Caucasian population, 15 suggesting the importance of calculating benchmark rates for GRFS in patients of different ethnicities.…”

Beneficial impact of low-dose rabbit anti-thymocyte globulin in unrelated hematopoietic stem cell transplantation: focusing on difference between stem cell sources

“…First, the risk of GVHD might differ among ethnicities and races. Asian populations were reported to have a lower risk of GVHD compared to Caucasian populations [12]. A Korean study showed that 2.5 mg/kg of ATG-T effectively reduced the incidence of GVHD [13], and our previous study showed that low-dose ATG was associated with a lower risk of chronic GVHD [4].…”

Reduced-dose methotrexate in combination with tacrolimus was associated with rapid engraftment and recovery from oral mucositis without affecting the incidence of GVHD

“…Several studies have reported that the systemic administration of folinic acid, which is routinely used to mitigate MTX toxicities, potentially reduces the incidence of severe oral mucositis after HSCT [25][26][27]. The incidence of GVHD in Japanese patients is lower than that in Caucasians [28,29], possibly due to the more homogenous genetic background of the Japanese population [30]. In many Japanese institutes, day +11 MTX is usually omitted in HLA-matched transplantation from a sibling donor [31,32], whereas four doses are standard in Western countries [15].…”