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Blood, 1 November 2002, Vol. 100, No. 9, pp. 3128-3134
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Chronic graft-versus-host disease after allogeneic blood stem
cell transplantation: long-term results of a randomized study
Mohamad Mohty,
Mathieu Kuentz,
Mauricette Michallet,
Jean-Henri Bourhis,
Noël Milpied,
Laurent Sutton,
Jean-Pierre Jouet,
Michel Attal,
Pierre Bordigoni,
Jean-Yves Cahn,
Jean-Michel Boiron, and
Didier Blaise for the
Société Française de Greffe
de Moelle et de Thérapie Cellulaire
(SFGM-TC)
From the Institut Paoli-Calmettes, Marseille, France;
Centre Hospitalier Universitaire (CHU) Henri Mondor, Créteil,
France; CHU Edouard Herriot, Lyon, France; Institut Gustave Roussy,
Villejuif, France; CHU Hôtel-Dieu, Nantes, France; CHU de la
Pitié Salpetrière, Paris, France; CHU Huriez, Lille,
France; CHU Purpan, Toulouse, France; CHU de Brabois, Nancy, France;
CHU J. Minjoz, Besançon, France; and CHU du Haut Levêque,
Bordeaux, France.
The use of peripheral blood stem cells (PBSCs) is rapidly growing
in the allogeneic transplantation setting as an alternative to bone
marrow (BM). We previously reported a higher incidence of chronic
graft-versus-host disease (cGVHD) associated with allogeneic PBSC
transplantation in a randomized trial. In this follow-up report, we
analyzed the evolution of cGVHD in the patients (n = 101) enrolled on
this study. At a median follow-up of 45 months (range, 31-57 months),
we found that the 3-year cumulative incidence of cGVHD was 65% (95%
confidence interval [CI] 51%-78%) in the PBSC group and
36% (95% CI 23%-49%) in the BM group (P = .004). We
also found that extensive cGVHD was more frequent in the PBSC group
(44% [95% CI 30%-58%] vs 17% [95% CI 7%-27%];
P = .004). The prevalence of cGVHD was always higher in
the PBSC arm. Ocular involvement was more frequent in PBSC recipients
(P = .02). Cutaneous and liver involvement was similar
among BM and PBSC recipients. Chronic GVHD required multiple courses of
immunosuppressive therapy in addition to cyclosporine and
corticosteroids during longer periods (P = .03).
Altogether, this translated into longer periods of hospitalization
after transplantation in the PBSC group (P = .04).
Finally, we also confirm that cGVHD after PBSC transplantation is
associated with an antileukemic effect that is at least as potent as
after BM. However, to date, this has not translated into a survival
difference, possibly due to the early-stage leukemic status of these
patients or to the relatively small size of the study population.
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