Disability related to chronic graft -versus-host disease after alternative donor hematopoietic cell transplantation
Giancarlo Fatobene,
Barry E. Storer,
Rachel B. Salit,
Stephanie J. Lee,
Paul J. Martin,
Guang-Shing Cheng,
Paul A. Carpenter,
Gansuvd Balgansuren,
Effie W. Petersdorf,
Colleen Delaney,
Brenda M. Sandmaier,
Filippo Milano,
Mary E. Flowers
Affiliations
Giancarlo Fatobene
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;Universidade de Sao Paulo, Hospital das Clinicas, SP, Brazil
Barry E. Storer
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA
Rachel B. Salit
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Stephanie J. Lee
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Paul J. Martin
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Guang-Shing Cheng
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Paul A. Carpenter
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Gansuvd Balgansuren
University of Washington, Division of Medical Oncology, Seattle, WA, USA;Seattle Cancer Care Alliance, Seattle, WA, USA
Effie W. Petersdorf
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Colleen Delaney
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Brenda M. Sandmaier
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Filippo Milano
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
Mary E. Flowers
Fred Hutchinson Cancer Research Center, Clinical Research Division, Seattle, WA, USA;University of Washington, Division of Medical Oncology, Seattle, WA, USA
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.
