Impact of graft-versus-host disease on relapse and survival after allogeneic stem cell transplantation for pediatric leukemia

• Published in: Bone marrow transplantation (Basingstoke) Vol. 54; no. 1; pp. 68 - 75
• Main Authors: Kato, Motohiro, Kurata, Mio, Kanda, Junya, Kato, Koji, Tomizawa, Daisuke, Kudo, Kazuko, Yoshida, Nao, Watanabe, Kenichiro, Shimada, Hiroyuki, Inagaki, Jiro, Koh, Katsuyoshi, Goto, Hiroaki, Kato, Keisuke, Cho, Yuko, Yuza, Yuki, Ogawa, Atsushi, Okada, Keiko, Inoue, Masami, Hashii, Yoshiko, Teshima, Takanori, Murata, Makoto, Atsuta, Yoshiko
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2019; Nature Publishing Group
• Subjects: 631/67/1990/283; 631/67/2324; Acute lymphoblastic leukemia; Acute myeloid leukemia; Adolescent; Allografts; Cell Biology; Cell survival; Child; Child, Preschool; Children; Chronic Disease; Disease-Free Survival; Female; Graft vs Host Disease - mortality; Graft vs Host Disease - prevention & control; Graft-versus-host reaction; Hematologic Neoplasms - mortality; Hematologic Neoplasms - therapy; Hematology; Humans; Infant; Infant, Newborn; Internal Medicine; Leukemia; Leukemia - mortality; Leukemia - therapy; Lymphatic leukemia; Male; Malignancy; Medicine; Medicine & Public Health; Morbidity; Myeloid leukemia; Pediatrics; Public Health; Recurrence; Stem Cell Transplantation; Stem Cells; Survival; Survival Rate; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-018-0221-6

Graft-versus-host disease (GVHD) occasionally leads to morbidity and mortality but is thought to reduce the risk of relapses in patients with a hematological malignancy. However, information on the effect of GVHD in pediatric leukemia is limited. Using a nationwide registry, we retrospectively analyzed 1526 children who underwent allogeneic stem cell transplantation for leukemia. Grades 0–I acute GVHD were associated with a higher relapse rate at three years after transplantation, at 25.4 and 24.3%, respectively, than grades II, III, or IV acute GVHD at 18.9%, 21.2%, and 2.6%, respectively. In contrast, the overall survival curve of the grades 0 and I GVHD groups (79.0% and 79.5%, respectively) approximated that of the grade II GVHD group (76.3%), and the probability of survival was worst in the severe GVHD groups (66.9% for grade III and 42.5% for grade IV). Chronic GVHD also reduced the relapse risk but conferred no survival advantage. Acute lymphoblastic leukemia was more sensitive to acute GVHD than acute myeloid leukemia (AML) while AML was more sensitive to chronic GVHD. Our study reproduced the preventive effects of GVHD against pediatric leukemia relapses but failed to demonstrate a significant survival advantage.