Graft vs. Host Disease Induced Graft vs. Leukemia Effect: Greater Impact on Relapse and Disease-Free Survival Following Reduced Intensity Conditioning

摘要

We studied GVHD on relapse, transplant-related mortality (TRM), disease-free (DFS) and survival (OS) after allogeneic transplantation for AML (n=4224) and MDS (n=1517) in four groups: without GVHD, acute GVHD alone, chronic GVHD alone, and acute + chronic GVHD. Examining GVHD as time dependent covariate, after myeloablative conditioning (MAC), chronic and acute + chronic GVHD were associated with lower relapse (p<0.002). TRM was higher in all GVHD groups (p<0.0001); DFS and OS were lower with acute ± chronic GVHD (p<0.0001). After reduced intensity conditioning (RIC), relapse was lower in all GVHD groups (p<0.0001); TRM was increased and DFS and OS were reduced with GVHD (p<0.0001). In those surviving disease-free (≥1-year) following MAC, relapse risks were similar in all groups and TRM higher with any GVHD (p<0.0001). DFS and OS were lower with chronic and acute + chronic GVHD (p<0.0006). After RIC, relapse was lower (p=0.009) and TRM higher (p=0.002) only with acute + chronic GVHD. DFS was similar in all groups and OS worse with acute + chronic GVHD. After MAC, GVHD has an adverse effect on TRM with early modest augmentation of GVHD-associated graft-versus-leukemia (GVL). With RIC, GVHD-associated GVL may be important in limiting both early and late leukemia recurrence.