Limits...
Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma.

Ringdén O, Shrestha S, da Silva GT, Zhang MJ, Dispenzieri A, Remberger M, Kamble R, Freytes CO, Gale RP, Gibson J, Gupta V, Holmberg L, Lazarus H, McCarthy P, Meehan K, Schouten H, Milone GA, Lonial S, Hari PN - Bone Marrow Transplant. (2011)

Bottom Line: We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC).In multivariate analysis, aGVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001).The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden.

ABSTRACT
We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42% (95% confidence interval (CI), 35-49%) and of chronic GVHD (cGVHD) at 5 years was 59% (95% CI, 49-69%), with 70% developing extensive cGVHD. In multivariate analysis, aGVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.

Show MeSH

Related in: MedlinePlus

Relapse in patients with and without chronic GVHD within one year (Landmark analysis)
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3369112&req=5

Figure 2: Relapse in patients with and without chronic GVHD within one year (Landmark analysis)

Mentions: Cumulative incidence of relapse at one year was 22% (95%CI, 16–28%). At five years, the incidence of relapse was 52% (95%CI, 41–63%). Acute GVHD had no statistically significant effect on the risk of relapse. Chronic GVHD overall was associated with a reduced risk of relapse in the multivariate analysis, but the beneficial effect was confined to those with limited cGVHD (RR=0.35, p=0.035) but was not statistically significant in those with extensive chronic GVHD (RR=0.58, p=0.14) (Table 3). Figure 2 represents the additional landmark analysis for relapse in those who developed any cGVHD within 1 year of HSCT vs. those who did not.


Effect of acute and chronic GVHD on relapse and survival after reduced-intensity conditioning allogeneic transplantation for myeloma.

Ringdén O, Shrestha S, da Silva GT, Zhang MJ, Dispenzieri A, Remberger M, Kamble R, Freytes CO, Gale RP, Gibson J, Gupta V, Holmberg L, Lazarus H, McCarthy P, Meehan K, Schouten H, Milone GA, Lonial S, Hari PN - Bone Marrow Transplant. (2011)

Relapse in patients with and without chronic GVHD within one year (Landmark analysis)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369112&req=5

Figure 2: Relapse in patients with and without chronic GVHD within one year (Landmark analysis)
Mentions: Cumulative incidence of relapse at one year was 22% (95%CI, 16–28%). At five years, the incidence of relapse was 52% (95%CI, 41–63%). Acute GVHD had no statistically significant effect on the risk of relapse. Chronic GVHD overall was associated with a reduced risk of relapse in the multivariate analysis, but the beneficial effect was confined to those with limited cGVHD (RR=0.35, p=0.035) but was not statistically significant in those with extensive chronic GVHD (RR=0.58, p=0.14) (Table 3). Figure 2 represents the additional landmark analysis for relapse in those who developed any cGVHD within 1 year of HSCT vs. those who did not.

Bottom Line: We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC).In multivariate analysis, aGVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001).The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden.

ABSTRACT
We evaluated the effect of acute and chronic GVHD on relapse and survival after allogeneic hematopoietic SCT (HSCT) for multiple myeloma using non-myeloablative conditioning (NMA) and reduced-intensity conditioning (RIC). The outcomes of 177 HLA-identical sibling HSCT recipients between 1997 and 2005, following NMA (n=98) or RIC (n=79) were analyzed. In 105 patients, autografting was followed by planned NMA/RIC allogeneic transplantation. The impact of GVHD was assessed as a time-dependent covariate using Cox models. The incidence of acute GVHD (aGVHD; grades I-IV) was 42% (95% confidence interval (CI), 35-49%) and of chronic GVHD (cGVHD) at 5 years was 59% (95% CI, 49-69%), with 70% developing extensive cGVHD. In multivariate analysis, aGVHD (≥ grade I) was associated with an increased risk of TRM (relative risk (RR)=2.42, P=0.016), whereas limited cGVHD significantly decreased the risk of myeloma relapse (RR=0.35, P=0.035) and was associated with superior EFS (RR=0.40, P=0.027). aGVHD had a detrimental effect on survival, especially in those receiving autologous followed by allogeneic HSCT (RR=3.52, P=0.001). The reduction in relapse risk associated with cGVHD is consistent with a beneficial graft-vs-myeloma effect, but this did not translate into a survival advantage.

Show MeSH
Related in: MedlinePlus