GvHD after umbilical cord blood transplantation for acute leukemia: An analysis of risk factors and effect on outcomes

Y. B. Chen, T. Wang, M. T. Hemmer, C. Brady, D. R. Couriel, A. Alousi, J. Pidala, A. Urbano-Ispizua, S. W. Choi, T. Nishihori, T. Teshima, Y. Inamoto, Baldeep Wirk, D. I. Marks, H. Abdel-Azim, L. Lehmann, L. Yu, M. Bitan, M. S. Cairo, M. QayedR. Salit, R. P. Gale, R. Martino, S. Jaglowski, A. Bajel, B. Savani, H. Frangoul, I. D. Lewis, J. Storek, M. Askar, M. A. Kharfan-Dabaja, M. Aljurf, O. Ringden, R. Reshef, R. F. Olsson, S. Hashmi, S. Seo, T. R. Spitzer, M. L. MacMillan, A. Lazaryan, S. R. Spellman, M. Arora, C. S. Cutler

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1404 umbilical cord blood transplantation (UCBT) patients (single (<18 years)=810, double (≥18 years)=594) with acute leukemia to define the incidence of acute GvHD (aGvHD) and chronic GvHD (cGvHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grade II-IV aGvHD was 39% (95% confidence interval (CI), 36-43%), grade III-IV aGvHD was 18% (95% CI, 15-20%) and 1-year cGvHD was 27% (95% CI, 24-30%). After double UCBT, 100-day incidence of grade II-IV aGvHD was 45% (95% CI, 41-49%), grade III-IV aGvHD was 22% (95% CI, 19-26%) and 1-year cGvHD was 26% (95% CI, 22-29%). For single UCBT, multivariate analysis showed that absence of antithymocyte globulin (ATG) was associated with aGvHD, whereas prior aGvHD was associated with cGvHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGvHD, whereas prior aGvHD predicted for cGvHD. Grade III-IV aGvHD led to worse survival, whereas cGvHD had no significant effect on disease-free or overall survival. GvHD is prevalent after UCBT with severe aGvHD leading to higher mortality. Future research in UCBT should prioritize prevention of GvHD.

Original languageEnglish (US)
Pages (from-to)400-408
Number of pages9
JournalBone Marrow Transplantation
Volume52
Issue number3
DOIs
StatePublished - Mar 1 2017

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Fetal Blood
Leukemia
Transplantation
Confidence Intervals
Antilymphocyte Serum
Incidence
Survival
Registries
Multivariate Analysis
Bone Marrow
Transplants
Mortality
Research

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Chen, Y. B., Wang, T., Hemmer, M. T., Brady, C., Couriel, D. R., Alousi, A., ... Cutler, C. S. (2017). GvHD after umbilical cord blood transplantation for acute leukemia: An analysis of risk factors and effect on outcomes. Bone Marrow Transplantation, 52(3), 400-408. https://doi.org/10.1038/bmt.2016.265
Chen, Y. B. ; Wang, T. ; Hemmer, M. T. ; Brady, C. ; Couriel, D. R. ; Alousi, A. ; Pidala, J. ; Urbano-Ispizua, A. ; Choi, S. W. ; Nishihori, T. ; Teshima, T. ; Inamoto, Y. ; Wirk, Baldeep ; Marks, D. I. ; Abdel-Azim, H. ; Lehmann, L. ; Yu, L. ; Bitan, M. ; Cairo, M. S. ; Qayed, M. ; Salit, R. ; Gale, R. P. ; Martino, R. ; Jaglowski, S. ; Bajel, A. ; Savani, B. ; Frangoul, H. ; Lewis, I. D. ; Storek, J. ; Askar, M. ; Kharfan-Dabaja, M. A. ; Aljurf, M. ; Ringden, O. ; Reshef, R. ; Olsson, R. F. ; Hashmi, S. ; Seo, S. ; Spitzer, T. R. ; MacMillan, M. L. ; Lazaryan, A. ; Spellman, S. R. ; Arora, M. ; Cutler, C. S. / GvHD after umbilical cord blood transplantation for acute leukemia : An analysis of risk factors and effect on outcomes. In: Bone Marrow Transplantation. 2017 ; Vol. 52, No. 3. pp. 400-408.
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abstract = "Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1404 umbilical cord blood transplantation (UCBT) patients (single (<18 years)=810, double (≥18 years)=594) with acute leukemia to define the incidence of acute GvHD (aGvHD) and chronic GvHD (cGvHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grade II-IV aGvHD was 39{\%} (95{\%} confidence interval (CI), 36-43{\%}), grade III-IV aGvHD was 18{\%} (95{\%} CI, 15-20{\%}) and 1-year cGvHD was 27{\%} (95{\%} CI, 24-30{\%}). After double UCBT, 100-day incidence of grade II-IV aGvHD was 45{\%} (95{\%} CI, 41-49{\%}), grade III-IV aGvHD was 22{\%} (95{\%} CI, 19-26{\%}) and 1-year cGvHD was 26{\%} (95{\%} CI, 22-29{\%}). For single UCBT, multivariate analysis showed that absence of antithymocyte globulin (ATG) was associated with aGvHD, whereas prior aGvHD was associated with cGvHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGvHD, whereas prior aGvHD predicted for cGvHD. Grade III-IV aGvHD led to worse survival, whereas cGvHD had no significant effect on disease-free or overall survival. GvHD is prevalent after UCBT with severe aGvHD leading to higher mortality. Future research in UCBT should prioritize prevention of GvHD.",
author = "Chen, {Y. B.} and T. Wang and Hemmer, {M. T.} and C. Brady and Couriel, {D. R.} and A. Alousi and J. Pidala and A. Urbano-Ispizua and Choi, {S. W.} and T. Nishihori and T. Teshima and Y. Inamoto and Baldeep Wirk and Marks, {D. I.} and H. Abdel-Azim and L. Lehmann and L. Yu and M. Bitan and Cairo, {M. S.} and M. Qayed and R. Salit and Gale, {R. P.} and R. Martino and S. Jaglowski and A. Bajel and B. Savani and H. Frangoul and Lewis, {I. D.} and J. Storek and M. Askar and Kharfan-Dabaja, {M. A.} and M. Aljurf and O. Ringden and R. Reshef and Olsson, {R. F.} and S. Hashmi and S. Seo and Spitzer, {T. R.} and MacMillan, {M. L.} and A. Lazaryan and Spellman, {S. R.} and M. Arora and Cutler, {C. S.}",
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Chen, YB, Wang, T, Hemmer, MT, Brady, C, Couriel, DR, Alousi, A, Pidala, J, Urbano-Ispizua, A, Choi, SW, Nishihori, T, Teshima, T, Inamoto, Y, Wirk, B, Marks, DI, Abdel-Azim, H, Lehmann, L, Yu, L, Bitan, M, Cairo, MS, Qayed, M, Salit, R, Gale, RP, Martino, R, Jaglowski, S, Bajel, A, Savani, B, Frangoul, H, Lewis, ID, Storek, J, Askar, M, Kharfan-Dabaja, MA, Aljurf, M, Ringden, O, Reshef, R, Olsson, RF, Hashmi, S, Seo, S, Spitzer, TR, MacMillan, ML, Lazaryan, A, Spellman, SR, Arora, M & Cutler, CS 2017, 'GvHD after umbilical cord blood transplantation for acute leukemia: An analysis of risk factors and effect on outcomes', Bone Marrow Transplantation, vol. 52, no. 3, pp. 400-408. https://doi.org/10.1038/bmt.2016.265

GvHD after umbilical cord blood transplantation for acute leukemia : An analysis of risk factors and effect on outcomes. / Chen, Y. B.; Wang, T.; Hemmer, M. T.; Brady, C.; Couriel, D. R.; Alousi, A.; Pidala, J.; Urbano-Ispizua, A.; Choi, S. W.; Nishihori, T.; Teshima, T.; Inamoto, Y.; Wirk, Baldeep; Marks, D. I.; Abdel-Azim, H.; Lehmann, L.; Yu, L.; Bitan, M.; Cairo, M. S.; Qayed, M.; Salit, R.; Gale, R. P.; Martino, R.; Jaglowski, S.; Bajel, A.; Savani, B.; Frangoul, H.; Lewis, I. D.; Storek, J.; Askar, M.; Kharfan-Dabaja, M. A.; Aljurf, M.; Ringden, O.; Reshef, R.; Olsson, R. F.; Hashmi, S.; Seo, S.; Spitzer, T. R.; MacMillan, M. L.; Lazaryan, A.; Spellman, S. R.; Arora, M.; Cutler, C. S.

In: Bone Marrow Transplantation, Vol. 52, No. 3, 01.03.2017, p. 400-408.

Research output: Contribution to journalArticle

TY - JOUR

T1 - GvHD after umbilical cord blood transplantation for acute leukemia

T2 - An analysis of risk factors and effect on outcomes

AU - Chen, Y. B.

AU - Wang, T.

AU - Hemmer, M. T.

AU - Brady, C.

AU - Couriel, D. R.

AU - Alousi, A.

AU - Pidala, J.

AU - Urbano-Ispizua, A.

AU - Choi, S. W.

AU - Nishihori, T.

AU - Teshima, T.

AU - Inamoto, Y.

AU - Wirk, Baldeep

AU - Marks, D. I.

AU - Abdel-Azim, H.

AU - Lehmann, L.

AU - Yu, L.

AU - Bitan, M.

AU - Cairo, M. S.

AU - Qayed, M.

AU - Salit, R.

AU - Gale, R. P.

AU - Martino, R.

AU - Jaglowski, S.

AU - Bajel, A.

AU - Savani, B.

AU - Frangoul, H.

AU - Lewis, I. D.

AU - Storek, J.

AU - Askar, M.

AU - Kharfan-Dabaja, M. A.

AU - Aljurf, M.

AU - Ringden, O.

AU - Reshef, R.

AU - Olsson, R. F.

AU - Hashmi, S.

AU - Seo, S.

AU - Spitzer, T. R.

AU - MacMillan, M. L.

AU - Lazaryan, A.

AU - Spellman, S. R.

AU - Arora, M.

AU - Cutler, C. S.

PY - 2017/3/1

Y1 - 2017/3/1

N2 - Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1404 umbilical cord blood transplantation (UCBT) patients (single (<18 years)=810, double (≥18 years)=594) with acute leukemia to define the incidence of acute GvHD (aGvHD) and chronic GvHD (cGvHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grade II-IV aGvHD was 39% (95% confidence interval (CI), 36-43%), grade III-IV aGvHD was 18% (95% CI, 15-20%) and 1-year cGvHD was 27% (95% CI, 24-30%). After double UCBT, 100-day incidence of grade II-IV aGvHD was 45% (95% CI, 41-49%), grade III-IV aGvHD was 22% (95% CI, 19-26%) and 1-year cGvHD was 26% (95% CI, 22-29%). For single UCBT, multivariate analysis showed that absence of antithymocyte globulin (ATG) was associated with aGvHD, whereas prior aGvHD was associated with cGvHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGvHD, whereas prior aGvHD predicted for cGvHD. Grade III-IV aGvHD led to worse survival, whereas cGvHD had no significant effect on disease-free or overall survival. GvHD is prevalent after UCBT with severe aGvHD leading to higher mortality. Future research in UCBT should prioritize prevention of GvHD.

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