A Prospective, Longitudinal Observation of the Incidence, Treatment, and Survival of Late Acute and Chronic Graft-versus-Host Disease by National Institutes of Health Criteria in a Japanese Cohort

Chikako Ohwada, Emiko Sakaida, Aiko Igarashi, Takeshi Kobayashi, Noriko Doki, Takehiko Mori, Jun Kato, Yuya Koda, Heiwa Kanamori, Masatsugu Tanaka, Takayoshi Tachibana, Shin Fujisawa, Yuki Nakajima, Ayumi Numata, Masako Toyosaki, Yasuyuki Aoyama, Makoto Onizuka, Maki Hagihara, Satoshi Koyama, Yoshinobu KandaHideki Nakasone, Hiroaki Shimizu, Seiko Kato, Reiko Watanabe, Katsuhiro Shono, Rika Sakai, Takeshi Saito, Chiaki Nakaseko, Shinichiro Okamoto

Research output: Contribution to journalArticle

Abstract

To prospectively validate the incidence, manifestations, and outcomes of graft-versus-host disease (GVHD) by National Institutes of Health criteria, we recruited 406 hematopoietic stem cell transplantation recipients at 16 transplant centers in Japan from May 2012 to June 2014. The 2-year cumulative incidence of late acute and chronic GVHD was 3.2% (n = 13) and 35.4% (n = 145), with a median onset of 3.6 and 4.7 months after transplant, respectively. The global severity at onset was mild in 30.3%, moderate in 43.5%, and severe in 26.2%. Eighty-two patients were followed up for 2 years, with 79.3% still manifesting GVHD symptoms, and 80.6% (n = 117) of the patients received systemic immunosuppressive treatment (IST), with a 2-year cumulative incidence of IST termination of 33.1%. Severe patients showed a significantly lower rate of IST termination than those with mild and moderate severities (mild, 38.5%; moderate, 40.9%; and severe, 17.2%). The 2-year incidence of nonrelapse mortality (NRM) and relapse was not significantly different according to the severity at onset (NRM: mild [16.6%] versus moderate [8.7%] versus severe [16.1%]; relapse: mild [14.9%] versus moderate [14.7%] versus severe [5.3%]). As a result, 2-year overall survival (OS) and GVHD-specific survival (GSS) were equivalent according to the severity at onset (mild: OS = 81.0%, GSS = 85.7%; moderate: OS = 84.2%, GSS = 92.5%; severe: OS = 83.9%, GSS = 89.2%). Our study helped identify the characteristics of late acute and chronic GVHD in Japanese patients. Further investigation is needed to identify an optimal endpoint for survival prediction.

Original languageEnglish (US)
Pages (from-to)162-170
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume26
Issue number1
DOIs
StatePublished - Jan 2020

Fingerprint

National Institutes of Health (U.S.)
Graft vs Host Disease
Observation
Survival
Incidence
Immunosuppressive Agents
Therapeutics
Transplants
Recurrence
Mortality
Hematopoietic Stem Cell Transplantation
Japan

Keywords

  • Chronic GVHD
  • Current cumulative incidence
  • GVHD-free, relapse-free survival
  • GVHD-specific survival
  • Late acute GVHD
  • NIH consensus criteria

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

A Prospective, Longitudinal Observation of the Incidence, Treatment, and Survival of Late Acute and Chronic Graft-versus-Host Disease by National Institutes of Health Criteria in a Japanese Cohort. / Ohwada, Chikako; Sakaida, Emiko; Igarashi, Aiko; Kobayashi, Takeshi; Doki, Noriko; Mori, Takehiko; Kato, Jun; Koda, Yuya; Kanamori, Heiwa; Tanaka, Masatsugu; Tachibana, Takayoshi; Fujisawa, Shin; Nakajima, Yuki; Numata, Ayumi; Toyosaki, Masako; Aoyama, Yasuyuki; Onizuka, Makoto; Hagihara, Maki; Koyama, Satoshi; Kanda, Yoshinobu; Nakasone, Hideki; Shimizu, Hiroaki; Kato, Seiko; Watanabe, Reiko; Shono, Katsuhiro; Sakai, Rika; Saito, Takeshi; Nakaseko, Chiaki; Okamoto, Shinichiro.

In: Biology of Blood and Marrow Transplantation, Vol. 26, No. 1, 01.2020, p. 162-170.

Research output: Contribution to journalArticle

Ohwada, C, Sakaida, E, Igarashi, A, Kobayashi, T, Doki, N, Mori, T, Kato, J, Koda, Y, Kanamori, H, Tanaka, M, Tachibana, T, Fujisawa, S, Nakajima, Y, Numata, A, Toyosaki, M, Aoyama, Y, Onizuka, M, Hagihara, M, Koyama, S, Kanda, Y, Nakasone, H, Shimizu, H, Kato, S, Watanabe, R, Shono, K, Sakai, R, Saito, T, Nakaseko, C & Okamoto, S 2020, 'A Prospective, Longitudinal Observation of the Incidence, Treatment, and Survival of Late Acute and Chronic Graft-versus-Host Disease by National Institutes of Health Criteria in a Japanese Cohort', Biology of Blood and Marrow Transplantation, vol. 26, no. 1, pp. 162-170. https://doi.org/10.1016/j.bbmt.2019.09.016
Ohwada, Chikako ; Sakaida, Emiko ; Igarashi, Aiko ; Kobayashi, Takeshi ; Doki, Noriko ; Mori, Takehiko ; Kato, Jun ; Koda, Yuya ; Kanamori, Heiwa ; Tanaka, Masatsugu ; Tachibana, Takayoshi ; Fujisawa, Shin ; Nakajima, Yuki ; Numata, Ayumi ; Toyosaki, Masako ; Aoyama, Yasuyuki ; Onizuka, Makoto ; Hagihara, Maki ; Koyama, Satoshi ; Kanda, Yoshinobu ; Nakasone, Hideki ; Shimizu, Hiroaki ; Kato, Seiko ; Watanabe, Reiko ; Shono, Katsuhiro ; Sakai, Rika ; Saito, Takeshi ; Nakaseko, Chiaki ; Okamoto, Shinichiro. / A Prospective, Longitudinal Observation of the Incidence, Treatment, and Survival of Late Acute and Chronic Graft-versus-Host Disease by National Institutes of Health Criteria in a Japanese Cohort. In: Biology of Blood and Marrow Transplantation. 2020 ; Vol. 26, No. 1. pp. 162-170.
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abstract = "To prospectively validate the incidence, manifestations, and outcomes of graft-versus-host disease (GVHD) by National Institutes of Health criteria, we recruited 406 hematopoietic stem cell transplantation recipients at 16 transplant centers in Japan from May 2012 to June 2014. The 2-year cumulative incidence of late acute and chronic GVHD was 3.2{\%} (n = 13) and 35.4{\%} (n = 145), with a median onset of 3.6 and 4.7 months after transplant, respectively. The global severity at onset was mild in 30.3{\%}, moderate in 43.5{\%}, and severe in 26.2{\%}. Eighty-two patients were followed up for 2 years, with 79.3{\%} still manifesting GVHD symptoms, and 80.6{\%} (n = 117) of the patients received systemic immunosuppressive treatment (IST), with a 2-year cumulative incidence of IST termination of 33.1{\%}. Severe patients showed a significantly lower rate of IST termination than those with mild and moderate severities (mild, 38.5{\%}; moderate, 40.9{\%}; and severe, 17.2{\%}). The 2-year incidence of nonrelapse mortality (NRM) and relapse was not significantly different according to the severity at onset (NRM: mild [16.6{\%}] versus moderate [8.7{\%}] versus severe [16.1{\%}]; relapse: mild [14.9{\%}] versus moderate [14.7{\%}] versus severe [5.3{\%}]). As a result, 2-year overall survival (OS) and GVHD-specific survival (GSS) were equivalent according to the severity at onset (mild: OS = 81.0{\%}, GSS = 85.7{\%}; moderate: OS = 84.2{\%}, GSS = 92.5{\%}; severe: OS = 83.9{\%}, GSS = 89.2{\%}). Our study helped identify the characteristics of late acute and chronic GVHD in Japanese patients. Further investigation is needed to identify an optimal endpoint for survival prediction.",
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AU - Sakaida, Emiko

AU - Igarashi, Aiko

AU - Kobayashi, Takeshi

AU - Doki, Noriko

AU - Mori, Takehiko

AU - Kato, Jun

AU - Koda, Yuya

AU - Kanamori, Heiwa

AU - Tanaka, Masatsugu

AU - Tachibana, Takayoshi

AU - Fujisawa, Shin

AU - Nakajima, Yuki

AU - Numata, Ayumi

AU - Toyosaki, Masako

AU - Aoyama, Yasuyuki

AU - Onizuka, Makoto

AU - Hagihara, Maki

AU - Koyama, Satoshi

AU - Kanda, Yoshinobu

AU - Nakasone, Hideki

AU - Shimizu, Hiroaki

AU - Kato, Seiko

AU - Watanabe, Reiko

AU - Shono, Katsuhiro

AU - Sakai, Rika

AU - Saito, Takeshi

AU - Nakaseko, Chiaki

AU - Okamoto, Shinichiro

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N2 - To prospectively validate the incidence, manifestations, and outcomes of graft-versus-host disease (GVHD) by National Institutes of Health criteria, we recruited 406 hematopoietic stem cell transplantation recipients at 16 transplant centers in Japan from May 2012 to June 2014. The 2-year cumulative incidence of late acute and chronic GVHD was 3.2% (n = 13) and 35.4% (n = 145), with a median onset of 3.6 and 4.7 months after transplant, respectively. The global severity at onset was mild in 30.3%, moderate in 43.5%, and severe in 26.2%. Eighty-two patients were followed up for 2 years, with 79.3% still manifesting GVHD symptoms, and 80.6% (n = 117) of the patients received systemic immunosuppressive treatment (IST), with a 2-year cumulative incidence of IST termination of 33.1%. Severe patients showed a significantly lower rate of IST termination than those with mild and moderate severities (mild, 38.5%; moderate, 40.9%; and severe, 17.2%). The 2-year incidence of nonrelapse mortality (NRM) and relapse was not significantly different according to the severity at onset (NRM: mild [16.6%] versus moderate [8.7%] versus severe [16.1%]; relapse: mild [14.9%] versus moderate [14.7%] versus severe [5.3%]). As a result, 2-year overall survival (OS) and GVHD-specific survival (GSS) were equivalent according to the severity at onset (mild: OS = 81.0%, GSS = 85.7%; moderate: OS = 84.2%, GSS = 92.5%; severe: OS = 83.9%, GSS = 89.2%). Our study helped identify the characteristics of late acute and chronic GVHD in Japanese patients. Further investigation is needed to identify an optimal endpoint for survival prediction.

AB - To prospectively validate the incidence, manifestations, and outcomes of graft-versus-host disease (GVHD) by National Institutes of Health criteria, we recruited 406 hematopoietic stem cell transplantation recipients at 16 transplant centers in Japan from May 2012 to June 2014. The 2-year cumulative incidence of late acute and chronic GVHD was 3.2% (n = 13) and 35.4% (n = 145), with a median onset of 3.6 and 4.7 months after transplant, respectively. The global severity at onset was mild in 30.3%, moderate in 43.5%, and severe in 26.2%. Eighty-two patients were followed up for 2 years, with 79.3% still manifesting GVHD symptoms, and 80.6% (n = 117) of the patients received systemic immunosuppressive treatment (IST), with a 2-year cumulative incidence of IST termination of 33.1%. Severe patients showed a significantly lower rate of IST termination than those with mild and moderate severities (mild, 38.5%; moderate, 40.9%; and severe, 17.2%). The 2-year incidence of nonrelapse mortality (NRM) and relapse was not significantly different according to the severity at onset (NRM: mild [16.6%] versus moderate [8.7%] versus severe [16.1%]; relapse: mild [14.9%] versus moderate [14.7%] versus severe [5.3%]). As a result, 2-year overall survival (OS) and GVHD-specific survival (GSS) were equivalent according to the severity at onset (mild: OS = 81.0%, GSS = 85.7%; moderate: OS = 84.2%, GSS = 92.5%; severe: OS = 83.9%, GSS = 89.2%). Our study helped identify the characteristics of late acute and chronic GVHD in Japanese patients. Further investigation is needed to identify an optimal endpoint for survival prediction.

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KW - Current cumulative incidence

KW - GVHD-free, relapse-free survival

KW - GVHD-specific survival

KW - Late acute GVHD

KW - NIH consensus criteria

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