Does an increased probability of graft‐vs‐host disease improve the survival of patients with adult T‐cell leukemia‐lymphoma? A simulation analysis using a Markov model

Abstract

Adult T-cell leukemia-lymphoma (ATL) is a peripheral T-cell lymphoma caused by human T-cell lymphotropic virus type I. Previous retrospective studies suggested the presence of graft-vs-ATL (GV-ATL) effects associated with acute graft-vs-host disease (GVHD), which suggests that intentional induction of acute GVHD to facilitate the efficacy of GV-ATL effects might reduce the risk of relapse and contribute to improved survival after allogeneic hematopoietic stem cell transplantation. However, it is impractical to conduct a prospective study to assess the benefit of intentional induction of acute GVHD. In a simulation analysis using a Markov model, we assessed the impact on overall survival (OS) of changing the probability of overall acute GVHD and severe acute GVHD. When the probability of grade III-IV acute GVHD changed 5 | CLINIC AL IMPLIC ATION 1. Based on the simulation results, preventive management of grade III-IV acute GVHD is mandatory to achieve the clinical benefit associated with grade I-II GVHD in allogeneic HSCT for ATL. 2.A simulation analysis like Markov model is commonly used in the setting of cost-effective analysis, but not in other settings.However, as shown in this paper, such simulation analyses might be useful in the clinical situation where prospective RCTs are practically inappropriate. ACK N OWLED G M ENTS