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Impact of graft-versus-host disease on the clinical outcome of allogeneic hematopoietic stem cell transplantation for non-malignant diseases

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Abstract

The impact of acute and chronic graft-versus-host disease (GVHD) on clinical outcomes was retrospectively analyzed in 960 patients with non-malignant diseases (NMD) who underwent a first allogeneic hematopoietic stem cell transplantation (HSCT). Grade III–IV acute GVHD (but not grade I–II) was significantly associated with a lower rate of overall survival (OS), and higher non-relapse mortality (NRM) than that seen in patients without acute GVHD. Extensive (but not limited) GVHD was significantly associated with a lower OS rate and higher NRM than that seen in patients without chronic GVHD. Any grade of acute (but not chronic) GVHD was significantly associated with a lower incidence of relapse and a lower proportion of patients requiring a second HSCT or donor lymphocyte infusion for graft failure or mixed chimerism, but its impact on OS was almost negligible. Acute GVHD was significantly associated with lower OS rates in all disease groups, whereas chronic GVHD was significantly associated with lower OS rates in the primary immunodeficiency and histiocytosis groups. In conclusion, acute and chronic GVHD, even if mild, was associated with reduced OS in patients receiving HSCT for NMD and effective strategies should, therefore, be implemented to minimize GVHD.

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Acknowledgements

We thank all the physicians and data managers at the transplant centers who contributed data to the Japan Society for Hematopoietic Cell Transplantation, the Japan Marrow Donor Program, the Japan Cord Blood Bank Network, and the Japanese Society of Pediatric Hematology/Oncology. We thank Dr. Junya Kanda for assistance with statistical analysis.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Graduate School of Medicine, Kyoto University, 54 Kawahara-choSakyo-ku, ShogoinKyoto, 606-8507, Japan

    Katsutsugu Umeda

  2. Department of Community Pediatrics, Perinatal and Maternal Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan

    Kohsuke Imai, Masakatsu Yanagimachi, Michiko Kajiwara & Tomohiro Morio

  3. Department of Cell Transplantation and Regenerative Medicine, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan

    Hiromasa Yabe

  4. Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan

    Masao Kobayashi

  5. Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Yoshiyuki Takahashi

  6. Department of Hematology and Oncology, Children’s Medical Center, Japanese Red Cross Nagoya First Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Nao Yoshida

  7. Department of Pediatrics, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan

    Yuko Cho

  8. Department of Hematology/Oncology, Osaka Women’s and Children’s Hospital, 840 Murodono-cho, Izumi, 594-1101, Japan

    Masami Inoue

  9. Department of Cancer Immunotherapy, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan

    Yoshiko Hashii

  10. Japanese Data Center for Hematopoietic Cell Transplantation, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, 461-0047, Japan

    Yoshiko Atsuta

Authors
  1. Katsutsugu Umeda
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  2. Kohsuke Imai
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  4. Hiromasa Yabe
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  6. Yoshiyuki Takahashi
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  8. Nao Yoshida
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  9. Yuko Cho
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  10. Masami Inoue
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  11. Yoshiko Hashii
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  12. Yoshiko Atsuta
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  13. Tomohiro Morio
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the Inherited Disease Working Group of the Japan Society for Hematopoietic Cell Transplantation

Contributions

KU, KI, MY, HY, and TM designed the research and organized the project; KU, KI, and YA performed statistical analysis and analyzed the data; KM, YT, MK, NY, and YC, MI, and YH gathered and organized the data; KU wrote the manuscript. All authors interpreted the data and reviewed and approved the manuscript.

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Correspondence to Katsutsugu Umeda.

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Umeda, K., Imai, K., Yanagimachi, M. et al. Impact of graft-versus-host disease on the clinical outcome of allogeneic hematopoietic stem cell transplantation for non-malignant diseases. Int J Hematol 111, 869–876 (2020). https://doi.org/10.1007/s12185-020-02839-4

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  • DOI: https://doi.org/10.1007/s12185-020-02839-4

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