Impact of conditioning intensity and TBI on acute GVHD after hematopoietic cell transplantation

• Published in: Bone marrow transplantation (Basingstoke) Vol. 50; no. 4; pp. 559 - 565
• Main Authors: Nakasone, H, Fukuda, T, Kanda, J, Mori, T, Yano, S, Kobayashi, T, Miyamura, K, Eto, T, Kanamori, H, Iwato, K, Uchida, N, Mori, S, Nagamura-Inoue, T, Ichinohe, T, Atsuta, Y, Teshima, T, Murata, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2015; Nature Publishing Group
• Subjects: 692/499; Acute Disease; Adolescent; Adult; Allografts; Analysis; Bone marrow; Cell Biology; Complications and side effects; Conditioning; Female; Graft vs Host Disease - etiology; Graft vs Host Disease - mortality; Graft vs. host disease; Graft-versus-host reaction; Hematologic Neoplasms - mortality; Hematologic Neoplasms - therapy; Hematology; Hematopoietic Stem Cell Transplantation; Histocompatibility antigen HLA; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate analysis; original-article; Patient outcomes; Public Health; Radiotherapy; Registries; Risk; Risk Factors; Stem cell transplantation; Stem Cells; Subgroups; Transplantation; Transplantation Conditioning; Transplants; Transplants & implants
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2014.293

The impact of the conditioning intensity and TBI on acute GVHD (aGVHD) is still a matter of debate. We analyzed 6848 adult recipients who received allogeneic hematopoietic cell transplants (HCT) between 2006 and 2011 in Japan. The subjects were divided into groups who had received myeloablative conditioning (MAC) or reduced-intensity conditioning (RIC), either with or without TBI. There was a significant difference in the incidence of aGVHD 2–4 among the different conditioning types: 39% in TBI-MAC, 35% in TBI-RIC and 32% in both no-TBI MAC and no-TBI-RIC ( P <0.001). In a multivariate analysis, TBI-MAC, but not no-TBI MAC, was significantly associated with an increased risk of aGVHD 2–4 (hazard ratio (HR) 1.33, P <0.01), whereas TBI-RIC was associated with an increased risk of GVHD 3–4 (HR 1.36, P =0.048). TBI-MAC and TBI-RIC were significantly associated with skin and gastrointestinal aGVHD. Subgroup analyses demonstrated that not only TBI-MAC, but also TBI-RIC, was significantly associated with aGVHD 2–4 in older patients. Furthermore, high-dose TBI only had an adverse impact on aGVHD 2–4 in HLA-matched HCT. Impacts of intensity and TBI on aGVHD differ by patient backgrounds, and this difference should be considered to establish a risk-adapted strategy for the prevention of aGVHD.