1.
Liver GVHD is Associated with Poor Survival Among Allogeneic Hematopoietic Stem Cell Transplant Recipients
Modi, D., Christine Ye, J., Surapaneni, M., Singh, V., Chen, W., Jang, H., Deol, A., Ayash, L., Alavi, A., Ratanatharathorn, V., et al
American journal of hematology. 2019
Abstract
Liver GVHD is common in patients with post-transplant liver dysfunction following allogeneic hematopoietic stem cell transplantation (AHSCT). Oftentimes, the diagnosis is made clinically, and liver biopsy is deferred. Our objective was to evaluate the risk factors and clinical outcomes of liver GVHD among patients who developed post-transplant liver dysfunction. Additionally, we evaluated the feasibility of liver biopsy in this population. We compared outcomes between liver GVHD and "non-liver GVHD" group which consisted of other etiologies of post-transplant liver dysfunction. Between January 2003 and December 2010, 249 patients developed post-transplant liver dysfunction following AHSCT 124 patients developed liver GVHD and 125 were in "non-liver GVHD" group. The incidence of acute and chronic liver GVHD at 1-year was 15.7% and 31.0%, respectively. The competing risk analysis revealed full intensity conditioning regimen (HR, 1.76; P=0.008) and related donor (HR, 1.68; P=0.004) as independent risk factors for liver GVHD. The time varying covariate cox regression analysis with competing risk event demonstrated that liver GVHD was independently associated with higher non-relapse mortality, and adverse relapse-free and overall survival. Total 112 liver biopsies were performed in 100 patients. No major complications were observed. Liver biopsy confirmed prebiopsy hypotheses in 49% of cases and led to treatment modification in 49% of patients. Our study shows that liver GVHD is associated with adverse survival. Liver biopsy is safe and often helps directing care in this setting. This article is protected by copyright. All rights reserved.
2.
Low incidence of severe cGvHD and late NRM in a phase II trial of thymoglobulin, tacrolimus and sirolimus for GvHD prevention
Al-Kadhimi, Z., Gul, Z., Abidi, M., Lum, L. G., Deol, A., Chen, W., Jang, H., Ozust, C., Langston, A., Waller, E., et al
Bone Marrow Transplantation. 2017;52(9):1304-1310
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Abstract
Chronic GvHD (cGvHD) is the leading cause of late non-relapse mortality (NRM) and morbidity after allogeneic hematopoietic stem cell transplant (AHSCT). We analyzed the late effects of a phase II trial testing the efficacy of intermediate dose rabbit anti-thymocyte globulin (Thymoglobulin Thymo) in combination with tacrolimus and sirolimus (TTS) in 47 patients (pts) for the prevention of acute and chronic GvHD after unrelated AHSCT. The median follow-up was 45.2 months. The cumulative incidence of NIH severe cGvHD at 48 months was 6.4% with no new occurrences past 6 months for the entire follow-up period. The overall cumulative incidence of cGvHD was 44.7%. Out of 20 pts who are alive and disease-free at the last follow-up, only 4 pts continue to need systemic immune suppression. We observed low late NRM with only 3 transplant-related deaths after 6 months post transplant. At 4 years of follow-up, the overall cumulative incidence of NRM and disease relapse was 27.7% and 30.0%, respectively. PFS and overall survival (OS) at 4 years were 42 and 47%. At long term follow-up, TTS was associated with low incidence of severe cGvHD and late NRM.