Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/31910
Title: Disability related to chronic graft-versus-host disease after alternative donor hematopoietic cell transplantation
Authors: FATOBENE, GiancarloSTORER, Barry E.SALIT, Rachel B.LEE, Stephanie J.MARTIN, Paul J.CHENG, Guang-ShingCARPENTER, Paul A.BALGANSUREN, GansuvdPETERSDORF, Effie W.DELANEY, ColleenSANDMAIER, Brenda M.MILANO, FilippoFLOWERS, Mary E.
Citation: HAEMATOLOGICA, v.104, n.4, p.835-843, 2019
Abstract: We determined the incidence of disability related to chronic graft-versus-host disease (bronchiolitis obliterans, grade >= 2 keratoconjunctivitis sicca, sclerotic features or esophageal stricture) for three categories of alternative donor: cord blood, haplorelated marrow or peripheral blood with post-transplant cyclophosphamide, and unrelated single HLA-allele mismatched peripheral blood. Among 396 consecutive hematopoietic cell transplant recipients, 129 developed chronic graft-versus-host disease with 3-year cumulative incidences of 8% for cord blood, 24% for haplorelated grafts, and 55% for unrelated single HLA-allele mismatched peripheral blood. Disability rates were significantly lower for cord blood [hazard ratio (HR) 0.13; 95% confidence interval (CI): 0.1-0.4] and for the haplorelated group (HR 0.31; 95% CI: 0.1-0.7) compared to the rate in the group transplanted with unrelated single HLA-allele mismatched peripheral blood. Cord blood recipients were also >2-fold more likely to return to work/school within 3 years from the onset of chronic graft-versus-host disease (HR 2.54; 95% CI: 1.1-5.7, P=0.02), and the haplorelated group trended similarly (HR 2.38; 95% CI: 1.0-5.9, P=0.06). Cord blood recipients were more likely to discontinue immunosuppression than were recipients of unrelated single HLA-allele mismatched peripheral blood (HR 3.96; 95% CI: 1.9-8.4, P=0.0003), similarly to the haplorelated group (HR 4.93; 95% CI: 2.2-11.1, P=0.0001). Progression-free survival and non-relapse mortality did not differ between groups grafted from different types of donors. Our observations that, compared to recipients of unrelated single HLA-allele mismatched peripheral blood, recipients of cord blood and haplorelated grafts less often developed disability related to chronic graft-versus-host disease, and were more likely to resume work/school, should help better counseling of pre-hematopoietic cell transplant candidates.
Appears in Collections:Artigos e Materiais de Revistas Científicas - HC/ICHC

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