Comparison of graft-versus-host disease-free, relapse-free survival according to a variety of graft sources: antithymocyte globulin and single cord blood provide favorable outcomes in some subgroups
Yoshihiro Inamoto,
Fumihiko Kimura,
Junya Kanda,
Junichi Sugita,
Kazuhiro Ikegame,
Hideki Nakasone,
Yasuhito Nannya,
Naoyuki Uchida,
Takahiro Fukuda,
Kosuke Yoshioka,
Yukiyasu Ozawa,
Ichiro Kawano,
Yoshiko Atsuta,
Koji Kato,
Tatsuo Ichinohe,
Masami Inoue,
Takanori Teshima
Affiliations
Yoshihiro Inamoto
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
Fumihiko Kimura
Division of Hematology, National Defense Medical College, Tokorozawa, Japan
Junya Kanda
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Junichi Sugita
Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Kazuhiro Ikegame
Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Hideki Nakasone
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Yasuhito Nannya
Department of Hematology, Gifu University Hospital, Tokyo, Japan
Naoyuki Uchida
Department of Hematology, Toranomon Hospital, Tokyo, Japan
Takahiro Fukuda
Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
Kosuke Yoshioka
Hematology Division, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Fukuoka, Japan
Yukiyasu Ozawa
Department of Hematology, Japanese Red Cross Nagoya First Hospital, Fukuoka, Japan
Ichiro Kawano
Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
Yoshiko Atsuta
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan;Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
Koji Kato
Department of Hematology and Oncology, Children’s Medical Center, Japanese Red Cross Nagoya First Hospital, Japan
Tatsuo Ichinohe
Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan
Masami Inoue
Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan
Takanori Teshima
Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Graft-versus-host disease-free relapse-free survival, which is defined as the absence of grade III–IV acute graft-versus-host disease, systemically treated chronic graft-versus-host disease, relapse, and death, is a novel, meaningful composite end point for clinical trials. To characterize risk factors and differences in graft-versus-host disease-free relapse-free survival according to a variety of graft sources, we analyzed 23,302 patients with hematologic malignancy that had a first allogeneic transplantation from 2000 through 2013 using the Japanese national transplant registry database. The 1-year graft-versus-host disease-free relapse-free survival rate was 41% in all patients. The rate was higher after bone marrow transplantation than after peripheral blood stem cell transplantation due to the lower risks of III–IV acute and chronic graft-versus-host disease. The rate was highest after HLA-matched sibling bone marrow transplantation. The rate after single cord blood transplantation was comparable to that after HLA-matched unrelated bone marrow transplantation among patients aged 20 years or under, and was comparable or better than other alternative graft sources among patients aged 21 years or over, due to the low risk of chronic graft-versus-host disease. Other factors associated with better graft-versus-host disease-free relapse-free survival include female patients, antithymocyte globulin prophylaxis (for standard-risk disease), recent years of transplantation, sex combinations other than from a female donor to a male patient, the absence of prior autologous transplantation, myeloablative conditioning, negative cytomegalovirus serostatus, and tacrolimus-based prophylaxis. These results provide important information to guide the choice of graft sources and are benchmarks for future graft-versus-host disease prophylaxis studies.
