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ctt-journal > Kuzmina Z.3 et al. (Abstract)

Kuzmina Z.3 et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract59
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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No significant difference in overall survival between patients with overlap syndrome and classic cGVHD: Prospective classification of chronic graft-versus-host disease (cGVHD) according to the new National Institutes of Health (NIH) consensus criteria

Zoya Kuzmina, Sandra Eder, Alexandra Böhm, Laurenz Vormittag, Peter Kalhs, Ventzislav Petkov, Georg Stary, Johannes Nepp, Hildegard T. Greinix

Medical University of Vienna, Vienna, Austria

Correspondence: Zoya Kuzmina, Medical University of Vienna, Internal Medicine I, Bone Marrow Transplantation Department, Waehringer Guertel 18-20, 1090, Vienna, Austria, E-mail: zoya.kuzmina@spam is badmeduniwien.ac.at

Abstract

Recently, the NIH Consensus Development Project on Criteria for Clinical Trials in chronic graft-versus-host disease (cGVHD) established new criteria for diagnosis and staging of cGVHD severity based on retrospective data and expert opinion. New definitions were proposed for both acute as well as cGVHD. However, their prognostic relevance with regard to patient outcome is currently unclear. We performed a prospective study on all consecutive patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) since 2005 to assess the prognostic impact of the new cGVHD staging criteria.

Patients: One hundred seventy-eight patients (85 males, 93 females) with a median age of 40 (range, 20–65) years alive on day +100 after HSCT with myeloablative (n=110) or reduced-intensity (n=68) conditioning and a related (n=37) or unrelated (n=141) stem cell donor were enrolled in the study. Fifteen received bone marrow, 162 blood stem cells, and 1 unrelated cord blood with a median of 6.6 (range, 1.33–14) x 106 CD34-positive cells per kg body weight. Starting on day +100 after HSCT all patients were assessed clinically every 3 months in the Outpatient Clinic for cGVHD activity according to the NIH consensus criteria (Filipovich AH et al, BBMT 2005;11:945-956).

Results: One hundred twenty-six (71%) patients experienced prior acute GVHD grades I to IV including 11 with recurrent, 15 with persistent, and 11 with late- onset acute GVHD. Median time to onset of acute GVHD was 18 (range, 9–120) days after HSCT. On day +100 ten patients had acute GVHD whereas 63 (35%) had cGVHD including 45 with classic cGVHD, and 18 with overlap syndrome, respectively. The overall incidence of cGVHD in our cohort was 69% with cGVHD occurring after a median of 151 (range, 82–510) days after HSCT. Ninety-two patients (75%) had classic cGVHD and 31 (25%) overlap syndrome. After a median follow-up of 25 (range, 3–60) months 21 patients died from transplant-related causes, including 2 with acute, 6 with overlap syndrome, 7 with classic and 6 with no cGVHD. The probability of overall survival (OS) at 4 years was significantly worse for patients without cGVHD with 39% (p=0.003) compared to 68% and 67% for patients with overlap syndrome and classic cGVHD, respectively.

Conclusions:
No significant differences in OS between the new categories of cGVHD were observed in our prospective study.

Keywords: hematopoietic stem cell transplantation, chronic graft-versus-host disease, overlap syndrome

 

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