Prognostic Factors on the Graft‐versus‐Host Disease‐Free and Relapse‐Free Survival after Adult Allogeneic Hematopoietic Stem Cell Transplantation

Abstract

The cure of hematologic disorders by allogeneic hematopoietic stem cell transplantation (HSCT) is often associated with major complications resulting in poor outcome, including graft-versus-host disease (GVHD), relapse, and death. A novel composite endpoint of GVHD-free/relapse-free survival (GRFS) in which events include grades 3-4 acute GVHD, chronic GVHD requiring systemic therapy, relapse, or death is censored to completely characterize the survival without mortality or ongoing morbidity. In this regard, studies attempting to identify the prognostic factors of GRFS are quite scarce. Thus, we reviewed 377 adult patients undergoing allogeneic HSCT between 2003 and 2013. The 1- and 2-year GRFS were 40.8% and 36.5%, respectively, significantly worse than overall survival and disease-free survival (log-rank p < 0.001). European Group for Blood and Marrow Transplantation (EBMT) risk score > 2 (p < 0.001) and hematologic malignancy (p = 0.033) were poor prognostic factors for 1-year GRFS. For 2-year GRFS, EBMT risk score > 2 (p < 0.001), being male (p = 0.028), and hematologic malignancy (p = 0.010) were significant for poor outcome. The events between 1-year GRFS and 2-year GRFS predominantly increased in relapsed patients. With prognostic factors of GRFS, we could evaluate the probability of real recovery following HSCT without ongoing morbidity.

Addition of Anti-thymocyte Globulin in Allogeneic Stem Cell Transplantation With Peripheral Stem Cells From Matched Unrelated Donors Improves Graft-Versus-Host Disease and Relapse Free Survival

“…GRFS is an increasingly recognized outcome measure after allo-HSCT (39). GRFS is defined as lack of severe aGvHD grade III-IV, cGvHD that necessitates systemic treatment, relapse and death (39)(40)(41). Our findings demonstrate that ATG increases GRFS by reducing severe acute and chronic GvHD which most likely increases quality of life (QoL).…”

Application of latent class analysis in diagnosis of graft-versus-host disease by serum markers after allogeneic haematopoietic stem cell transplantation

“…During the last few decades, substantial progress has been made with regard to HSCT management due to the improved diagnostic procedures and novel therapies. In HSCT success is limited by two main factors: transplant-related morbidity or mortality (TRM) and disease relapse 4 . Graft-versus-host disease (GVHD) is the major cause of TRM which classified as either acute GVHD (aGVHD) or chronic GVHD (cGVHD) 2 .…”

Establishing a standardized system for review and adjudication of chronic graft‐vs‐host disease data in accordance with the National Institutes Consensus criteria

“…The NIH further refined these guidelines in 2014 . In recent years, the prognostic value of the NIH consensus criteria (NCC) has been validated supporting the use of this new system . While most of Bone Marrow Transplant (BMT) centers have adopted these guidelines into their routine clinical assessments, GVHD evaluation requires laborious time‐consuming assessments and can lead to clinician inter‐variability in both diagnosis and scoring of GVHD.…”