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Effect of graft-versus-host disease on the outcome of bone marrow transplantation from an HLA-identical sibling donor using GVHD prophylaxis with cyclosporin A and methotrexate

Leukemia volume 18, pages 1013–1019 (2004)Cite this article

Abstract

The effect of graft-versus-host disease (GVHD) on relapse incidence and survival has been analyzed in several studies, but previous studies included heterogeneous patients. Therefore, we analyzed the data of 2114 patients who received unmanipulated bone marrow graft from an HLA-identical sibling donor with a GVHD prophylaxis using cyclosporin A and methotrexate. Among the 1843 patients who survived without relapse at 60 days after transplantation, 435 (24%) developed grade II–IV acute GVHD. Among the 1566 patients who survived without relapse at 150 days after transplantation, 705 (47%) developed chronic GVHD. The incidence of relapse was significantly lower in patients who developed acute or chronic GVHD, but disease-free survival (DFS) was significantly inferior in patients who developed acute GVHD. A benefit of ‘mild’ GVHD was only seen in high-risk patients who developed grade I acute GVHD. The strongest association between GVHD and a decreased incidence of relapse was observed in patients with standard-risk acute myelogenous leukemia/myelodysplastic syndrome. In conclusion, the therapeutic window between decreased relapse and increased transplant-related mortality due to the development of GVHD appeared to be very narrow.

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Authors and Affiliations

  1. Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Japan

    Y Kanda, K Izutsu & H Hirai

  2. Hematology Division, Tokyo Metropolitan Komagome Hospital, Japan

    H Sakamaki

  3. Department of Transfusion Medicine and Cell Therapy, Institute of Medical Science, University of Tokyo, Japan

    T Iseki

  4. Japanese Red Cross Nagoya First Hospital, Japan

    Y Kodera

  5. Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan

    S Okamoto

  6. Department of Hematology/Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Japan

    H Mitsui & A Hiraoka

  7. Department of Internal Medicine, Hiroshima Red Cross Hospital and Hiroshima Atomic Bomb Survivors Hospital, Japan

    K Iwato

  8. Department of Hematology, Nagoya Daini Red Cross Hospital, Japan

    N Hirabayashi

  9. Division of Bone Marrow Transplantation, Niigata University Medical Hospital, Japan

    T Furukawa

  10. Department of Hematology, Kanagawa Cancer Center, Japan

    A Maruta

  11. Department of Internal Medicine, Sapporo Hokuyu Hospital, Japan

    M Kasai

  12. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Japan

    Y Atsuta & N Hamajima

  13. Department of Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan

    K Kawa

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  1. Y Kanda
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Correspondence to Y Kanda.

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Kanda, Y., Izutsu, K., Hirai, H. et al. Effect of graft-versus-host disease on the outcome of bone marrow transplantation from an HLA-identical sibling donor using GVHD prophylaxis with cyclosporin A and methotrexate. Leukemia 18, 1013–1019 (2004). https://doi.org/10.1038/sj.leu.2403343

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