Graft-versus-host disease treatment: predictors of survival
John E Levine, Brent Logan, Juan Wu, Amin M Alousi, Vincent Ho, Javier Bolaños-Meade, Daniel Weisdorf, Blood and Marrow Transplant Clinical Trials Network, Amin M Alousi, Javier Bolaños-Meade, Georgia Vogelsang, Daniel Weisdorf, Vincent Ho, Robert Soiffer, Joseph Antin, John Levine, James L Ferrara, Eneida Nemecek, John Wingard, Steven Goldstein, Edward Stadtmauer, Marcel Devetten, John DiPersio, Peter Westervelt, Laura Johnston, Edward Ball, Nelson Chao, Joanne Kurtzberg, Hillard Lazarus, Nancy Kernan, Miguel-Angel Perales, Carlos Bachier, Michael Grimley, Paul Shaughnessy, Pablo Parker, Richard Nash, Joel Brochstein, John E Levine, Brent Logan, Juan Wu, Amin M Alousi, Vincent Ho, Javier Bolaños-Meade, Daniel Weisdorf, Blood and Marrow Transplant Clinical Trials Network, Amin M Alousi, Javier Bolaños-Meade, Georgia Vogelsang, Daniel Weisdorf, Vincent Ho, Robert Soiffer, Joseph Antin, John Levine, James L Ferrara, Eneida Nemecek, John Wingard, Steven Goldstein, Edward Stadtmauer, Marcel Devetten, John DiPersio, Peter Westervelt, Laura Johnston, Edward Ball, Nelson Chao, Joanne Kurtzberg, Hillard Lazarus, Nancy Kernan, Miguel-Angel Perales, Carlos Bachier, Michael Grimley, Paul Shaughnessy, Pablo Parker, Richard Nash, Joel Brochstein
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.
Copyright © 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
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Source: PubMed