Affiliation:
1. From the Johns Hopkins Oncology Center, Division of Hematologic Malignancies/BMT, and Oncology Biostatistics, Baltimore, MD.
Abstract
The disease-specific survival (DSS) of 151 patients with chronic graft-versus-host disease (cGVHD) was studied in an attempt to stratify patients into risk groups and to form a basis for a new grading of cGVHD. The data included the outcome and 23 variables at the diagnosis of cGVHD and at the primary treatment failure (PTF). Eighty-nine patients (58%) failed primary therapy for cGVHD. Nonrelapse mortality was 44% after a median follow-up of 7.8 years. The probability of DSS at 10 years after diagnosis of cGVHD (DSS1) and after PTF (DSS2) was 51% (95% confidence interval [CI] = 39%, 60%) and 38% (95% CI = 28%, 49%), respectively. According to multivariate analysis, extensive skin involvement (ESI) more than 50% of body surface area; hazard ratio (HR) of 7.0 (95% CI = 3.6-13.4), thrombocytopenia (TP) (< 100 000/μL; HR, 3.6; 95% CI = 1.9-6.8), and progressive-type onset (PTO) (HR, 1.7; 95% CI = 0.9-3.0) significantly influenced DSS1. These 3 factors and Karnofsky Performance Score of less than 50% at PTF were significant predictors for DSS2. The DSS1 at 10 years for patients with prognostic factor score (PFS) at diagnosis of 0 (none), less than 2 (ESI only or TP and/or PTO), 2 to 3.5 (ESI plus either TP or PTO), and more than 3.5 (all 3 factors) was 82%, 68%, 34%, and 3% (P = .05, < .001, < .001), respectively. The DSS2 at 5 years for patients with PFS at PTF of 0, 2 or less, 2 to 3.5, and more than 3.5 were 91%, 71%, 22%, and 4% (P = .2, .005, and < .001), respectively. It was concluded that these prognostic models might be useful in grouping the patients with similar outcome.
Publisher
American Society of Hematology
Subject
Cell Biology,Hematology,Immunology,Biochemistry
Reference30 articles.
1. Allogeneic bone marrow transplantation for chronic myeloid leukemia using sibling and volunteer unrelated donors: a comparison of complications in the first 2 years.;Marks;Ann Intern Med.,1993
2. A prospective, randomized trial of peripheral blood stem cells (PBS) or marrow (BM) for patients undergoing allogeneic transplantation for hematologic malignancies [abstract].;Bensinger;Blood.,1999
3. Randomized trial of bone marrow versus lenograstim-primed blood cell allogeneic transplantation in patients with early-stage leukemia: a report from the Societe Francaise de Greffe de Moelle.;Blaise;J Clin Oncol.,2000
4. A randomized trial of filgrastim (G-CSF) stimulated donor marrow (BM) versus peripheral blood (PBPC) for allogeneic transplantation: increased extensive chronic graft versus host disease following PBPC transplantation [abstract].;Durrant;Blood.,1999
5. The importance of confirming graft versus host disease (GVHD) diagnosis [abstract].;Montross;Blood.,1998