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Incidence, Risk Factors, and Outcomes of Chronic Graft-versus-Host Disease in Pediatric Patients with Hematologic Malignancies after T Cell-Replete Myeloablative Haploidentical Hematopoietic Stem Cell Transplantation with Antithymocyte Globulin/Granulocyte Colony-Stimulating Factor.
Biol Blood Marrow Transplant. 2020 Jun 03 [Online ahead of print]BB

Abstract

The specific description, risk factors, and outcomes of chronic graft-versus-host disease (cGVHD) in pediatric patients with hematologic malignancies after T cell-replete (TCR) myeloablative haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with antithymocyte globulin (ATG)/granulocyte colony-stimulating factor (G-CSF) have not been previously well described. We retrospectively analyzed the incidence, risk factors, and outcomes of cGVHD documented according to the 2014 National Institutes of Health consensus criteria (NIH-CC) in 292 consecutive pediatric patients with hematologic malignancies after TCR myeloablative haplo-HSCT with ATG/G-CSF between January 2015 and December 2017. A total of 170 patients experienced cGVHD. The 3-year cumulative incidence of total cGVHD and mild, moderate, and severe cGVHD was 57.9%, 27.5%, 18.8%, and 11.9%, respectively. Multivariate analysis showed that acute GVHD (aGVHD) grade II-IV (hazard ratio, 1.578; P = .002) was an independent risk factor for cGVHD. Compared to patients without cGVHD, patients with cGVHD demonstrated a lower 3-year relapse (17.6% versus 27.2%; P = .009), a similar 3-year nonrelapse mortality (NRM) (5.9% versus 5.4%; P = .79), and better 3-year disease-free survival (DFS) (77.8% versus 66.9%; P = .007) and overall survival (OS) (81.3% versus 68.6%; P = .001), particularly those with mild or moderate cGVHD; however, no significant impact of severe cGVHD on relapse, NRM, DFS, or OS was seen. In conclusion, the incidence of severe cGVHD in pediatric patients with hematologic malignancies after TCR myeloablative haplo-HSCT with ATG/G-CSF was acceptable. Previous aGVHD grade II-IV was a risk factor for the occurrence of cGVHD. Only mild or moderate cGVHD was associated with a lower risk of relapse, translating into improved DFS and OS in pediatric patients with hematologic malignancies after TCR myeloablative haplo-HSCT with ATG/G-CSF.

Authors+Show Affiliations

Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Peking-Tsinghua Center for Life Sciences, Beijing, China; Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, China.Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China. Electronic address: ywyw3172@sina.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32504861

Citation

Tang, Fei-Fei, et al. "Incidence, Risk Factors, and Outcomes of Chronic Graft-versus-Host Disease in Pediatric Patients With Hematologic Malignancies After T Cell-Replete Myeloablative Haploidentical Hematopoietic Stem Cell Transplantation With Antithymocyte Globulin/Granulocyte Colony-Stimulating Factor." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 2020.
Tang FF, Cheng YF, Xu LP, et al. Incidence, Risk Factors, and Outcomes of Chronic Graft-versus-Host Disease in Pediatric Patients with Hematologic Malignancies after T Cell-Replete Myeloablative Haploidentical Hematopoietic Stem Cell Transplantation with Antithymocyte Globulin/Granulocyte Colony-Stimulating Factor. Biol Blood Marrow Transplant. 2020.
Tang, F. F., Cheng, Y. F., Xu, L. P., Zhang, X. H., Yan, C. H., Han, W., Chen, Y. H., Huang, X. J., & Wang, Y. (2020). Incidence, Risk Factors, and Outcomes of Chronic Graft-versus-Host Disease in Pediatric Patients with Hematologic Malignancies after T Cell-Replete Myeloablative Haploidentical Hematopoietic Stem Cell Transplantation with Antithymocyte Globulin/Granulocyte Colony-Stimulating Factor. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation. https://doi.org/10.1016/j.bbmt.2020.05.021
Tang FF, et al. Incidence, Risk Factors, and Outcomes of Chronic Graft-versus-Host Disease in Pediatric Patients With Hematologic Malignancies After T Cell-Replete Myeloablative Haploidentical Hematopoietic Stem Cell Transplantation With Antithymocyte Globulin/Granulocyte Colony-Stimulating Factor. Biol Blood Marrow Transplant. 2020 Jun 3; PubMed PMID: 32504861.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence, Risk Factors, and Outcomes of Chronic Graft-versus-Host Disease in Pediatric Patients with Hematologic Malignancies after T Cell-Replete Myeloablative Haploidentical Hematopoietic Stem Cell Transplantation with Antithymocyte Globulin/Granulocyte Colony-Stimulating Factor. AU - Tang,Fei-Fei, AU - Cheng,Yi-Fei, AU - Xu,Lan-Ping, AU - Zhang,Xiao-Hui, AU - Yan,Chen-Hua, AU - Han,Wei, AU - Chen,Yu-Hong, AU - Huang,Xiao-Jun, AU - Wang,Yu, Y1 - 2020/06/03/ PY - 2020/03/17/received PY - 2020/05/20/revised PY - 2020/05/20/accepted PY - 2020/6/7/pubmed PY - 2020/6/7/medline PY - 2020/6/7/entrez KW - Chronic graft-versus-host disease KW - Haploidentical hematopoietic stem cell transplantation KW - Pediatric patients JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol. Blood Marrow Transplant. N2 - The specific description, risk factors, and outcomes of chronic graft-versus-host disease (cGVHD) in pediatric patients with hematologic malignancies after T cell-replete (TCR) myeloablative haploidentical hematopoietic stem cell transplantation (haplo-HSCT) with antithymocyte globulin (ATG)/granulocyte colony-stimulating factor (G-CSF) have not been previously well described. We retrospectively analyzed the incidence, risk factors, and outcomes of cGVHD documented according to the 2014 National Institutes of Health consensus criteria (NIH-CC) in 292 consecutive pediatric patients with hematologic malignancies after TCR myeloablative haplo-HSCT with ATG/G-CSF between January 2015 and December 2017. A total of 170 patients experienced cGVHD. The 3-year cumulative incidence of total cGVHD and mild, moderate, and severe cGVHD was 57.9%, 27.5%, 18.8%, and 11.9%, respectively. Multivariate analysis showed that acute GVHD (aGVHD) grade II-IV (hazard ratio, 1.578; P = .002) was an independent risk factor for cGVHD. Compared to patients without cGVHD, patients with cGVHD demonstrated a lower 3-year relapse (17.6% versus 27.2%; P = .009), a similar 3-year nonrelapse mortality (NRM) (5.9% versus 5.4%; P = .79), and better 3-year disease-free survival (DFS) (77.8% versus 66.9%; P = .007) and overall survival (OS) (81.3% versus 68.6%; P = .001), particularly those with mild or moderate cGVHD; however, no significant impact of severe cGVHD on relapse, NRM, DFS, or OS was seen. In conclusion, the incidence of severe cGVHD in pediatric patients with hematologic malignancies after TCR myeloablative haplo-HSCT with ATG/G-CSF was acceptable. Previous aGVHD grade II-IV was a risk factor for the occurrence of cGVHD. Only mild or moderate cGVHD was associated with a lower risk of relapse, translating into improved DFS and OS in pediatric patients with hematologic malignancies after TCR myeloablative haplo-HSCT with ATG/G-CSF. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/32504861/cGVHD_in_pediatric_haplo-HSCT L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(20)30342-6 DB - PRIME DP - Unbound Medicine ER -
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