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Graft-versus-host disease treatment: predictors of survival.
- Source :
-
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2010 Dec; Vol. 16 (12), pp. 1693-9. Date of Electronic Publication: 2010 Jun 09. - Publication Year :
- 2010
-
Abstract
- Acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic cell transplant (HCT) is the major reason for nonrelapse mortality (NRM), and thus is a major determinant of long-term survival. Clinical trials of new aGVHD treatments are needed to identify approaches that will ultimately improve upon HCT survival. At present, it is not clear how quickly response to GVHD treatment needs to be established to reliably categorize patients at high risk for death or to promptly identify those who might benefit from alternate treatment. Therefore, we analyzed time to response from onset of aGVHD treatment in 180 patients who were enrolled on a national, randomized, phase II aGVHD treatment clinical trial whose initial treatment of GVHD consisted of high-dose steroids plus a second immunosuppressive agent. The aim of this analysis was to determine whether time to aGVHD treatment response predicts patient outcomes, especially survival. We used response at 14, 28, and 56 days from initiation of aGVHD treatment to categorize patients for NRM and survival. Multivariate analyses and specificity/sensitivity analyses identified that day 28 response (complete or partial response) best categorized patients by NRM and survival at 9 months from start of aGVHD treatment. If verified as a reliable predictor of late outcomes following other aGVHD treatment approaches, day 28 response should serve as a standard early endpoint for future trials of aGVHD therapy.<br /> (Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adrenal Cortex Hormones administration & dosage
Adult
Diphtheria Toxin administration & dosage
Etanercept
Graft vs Host Disease etiology
Hematologic Diseases surgery
Humans
Immunoglobulin G administration & dosage
Interleukin-2 administration & dosage
Methylprednisolone administration & dosage
Middle Aged
Pentostatin administration & dosage
Receptors, Tumor Necrosis Factor administration & dosage
Recombinant Fusion Proteins administration & dosage
Survival Analysis
Treatment Outcome
Graft vs Host Disease drug therapy
Hematopoietic Stem Cell Transplantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1523-6536
- Volume :
- 16
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 20541024
- Full Text :
- https://doi.org/10.1016/j.bbmt.2010.05.019