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Graft-Versus-Host Disease

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

Bone Marrow Transplantation volume 50, pages 559–565 (2015)Cite this article

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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.

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Acknowledgements

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).

Author Contributions

HN and TF designed the study, analyzed the data and wrote the manuscript. JK, TM, SY and TT advised on methods and wrote the manuscript. TK, KM, TE, HK, KI and NU collected the data. SM, TN and TI collected the data and were responsible for data management for JMDP, JCBBN and JSHCT, respectively. YA analyzed and managed the unified registry database and wrote the manuscript. MM advised on the methods, wrote the manuscript and was responsible for the GVHD-WG of the JSHCT.

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Authors and Affiliations

  1. Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA, USA

    H Nakasone

  2. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    H Nakasone & J Kanda

  3. Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan

    T Fukuda

  4. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Mori

  5. Division of Clinical Oncology and Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan

    S Yano

  6. Hematology Division, Tokyo Metropolitan Cancer & Infectious Disease Center, Komagome Hospital, Tokyo, Japan

    T Kobayashi

  7. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Miyamura

  8. Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan

    T Eto

  9. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

    H Kanamori

  10. Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors, Hiroshima, Japan

    K Iwato

  11. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    N Uchida

  12. Division of Hematology and Oncology, St Luke’s International Hospital, Tokyo, Japan

    S Mori

  13. Department of Cell Processing and Transfusion, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    T Nagamura-Inoue

  14. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    T Ichinohe

  15. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Y Atsuta

  16. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta

  17. Department of Hematology, Hokkaido University Graduate School of Medical Science, Sapporo, Japan

    T Teshima

  18. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    M Murata

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  1. H Nakasone
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  9. H Kanamori
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  15. Y Atsuta
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  16. T Teshima
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  17. M Murata
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on behalf of the GVHD working group of the Japan Society of Hematopoietic Cell Transplantation

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Correspondence to H Nakasone.

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Nakasone, H., Fukuda, T., Kanda, J. et al. Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation. Bone Marrow Transplant 50, 559–565 (2015). https://doi.org/10.1038/bmt.2014.293

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