Cargando…

Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution

Long-term follow-up studies are crucial to ensure surveillance and intervention for late complications after allogeneic stem cell transplantation, but they are scarce on the pediatric population. This study aims to analyze risk factors for long-term transplant outcomes. We report a landmark analysis...

Descripción completa

Detalles Bibliográficos
Autores principales: Molina, Blanca, González-Vicent, Marta, Lopez, Ivan, Pereto, Alba, Ruiz, Julia, Ramirez, Manuel, Díaz, Miguel A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411718/
https://www.ncbi.nlm.nih.gov/pubmed/36034564
http://dx.doi.org/10.3389/fped.2022.947531
_version_ 1784775332345151488
author Molina, Blanca
González-Vicent, Marta
Lopez, Ivan
Pereto, Alba
Ruiz, Julia
Ramirez, Manuel
Díaz, Miguel A.
author_facet Molina, Blanca
González-Vicent, Marta
Lopez, Ivan
Pereto, Alba
Ruiz, Julia
Ramirez, Manuel
Díaz, Miguel A.
author_sort Molina, Blanca
collection PubMed
description Long-term follow-up studies are crucial to ensure surveillance and intervention for late complications after allogeneic stem cell transplantation, but they are scarce on the pediatric population. This study aims to analyze risk factors for long-term transplant outcomes. We report a landmark analysis of 162 pediatric patients who underwent allogeneic transplantation between 1991 and 2016, and survived for at least 12 months after the transplant. With a median follow-up time of 10 years for the survivors, the probability of disease-free survival (DFS) and overall survival (OS) is 81 ± 3 and 88 ± 2%, respectively. Variables that influenced DFS in the univariate analysis were: disease phase (early phase 87 ± 3% vs. advanced phase 74 ± 5%; p = 0.04), acute graft vs. host disease (aGvHD; yes 73 ± 5% vs. no 87 ± 3%; p = 0.038), severe chronic GvHD (cGvHD; yes 41 ± 13% vs. no 85 ± 3%; p = 0.0001), and CD4+ lymphocytes 2 years after the transplant (above the median of 837/μl 98 ± 2% vs. below the median 82 ± 6%, p = 0.026). However, in the multivariate analysis, the only variable that influenced DFS was presence of severe chronic GvHD (yes vs. no, HR 6.25; 95% CI, 1.35–34.48; p = 0.02). Transplant strategies should aim to reduce the risk of severe cGvHD. Immune reconstitution surveillance may help clinicians to better deal with late transplant complications.
format Online
Article
Text
id pubmed-9411718
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-94117182022-08-27 Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution Molina, Blanca González-Vicent, Marta Lopez, Ivan Pereto, Alba Ruiz, Julia Ramirez, Manuel Díaz, Miguel A. Front Pediatr Pediatrics Long-term follow-up studies are crucial to ensure surveillance and intervention for late complications after allogeneic stem cell transplantation, but they are scarce on the pediatric population. This study aims to analyze risk factors for long-term transplant outcomes. We report a landmark analysis of 162 pediatric patients who underwent allogeneic transplantation between 1991 and 2016, and survived for at least 12 months after the transplant. With a median follow-up time of 10 years for the survivors, the probability of disease-free survival (DFS) and overall survival (OS) is 81 ± 3 and 88 ± 2%, respectively. Variables that influenced DFS in the univariate analysis were: disease phase (early phase 87 ± 3% vs. advanced phase 74 ± 5%; p = 0.04), acute graft vs. host disease (aGvHD; yes 73 ± 5% vs. no 87 ± 3%; p = 0.038), severe chronic GvHD (cGvHD; yes 41 ± 13% vs. no 85 ± 3%; p = 0.0001), and CD4+ lymphocytes 2 years after the transplant (above the median of 837/μl 98 ± 2% vs. below the median 82 ± 6%, p = 0.026). However, in the multivariate analysis, the only variable that influenced DFS was presence of severe chronic GvHD (yes vs. no, HR 6.25; 95% CI, 1.35–34.48; p = 0.02). Transplant strategies should aim to reduce the risk of severe cGvHD. Immune reconstitution surveillance may help clinicians to better deal with late transplant complications. Frontiers Media S.A. 2022-08-12 /pmc/articles/PMC9411718/ /pubmed/36034564 http://dx.doi.org/10.3389/fped.2022.947531 Text en Copyright © 2022 Molina, González-Vicent, Lopez, Pereto, Ruiz, Ramirez and Díaz. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Molina, Blanca
González-Vicent, Marta
Lopez, Ivan
Pereto, Alba
Ruiz, Julia
Ramirez, Manuel
Díaz, Miguel A.
Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
title Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
title_full Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
title_fullStr Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
title_full_unstemmed Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
title_short Long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
title_sort long-term transplant outcomes after allogeneic hematopoietic transplant in pediatric patients with hematological malignancies are influenced by severe chronic graft vs. host disease and immune reconstitution
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9411718/
https://www.ncbi.nlm.nih.gov/pubmed/36034564
http://dx.doi.org/10.3389/fped.2022.947531
work_keys_str_mv AT molinablanca longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution
AT gonzalezvicentmarta longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution
AT lopezivan longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution
AT peretoalba longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution
AT ruizjulia longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution
AT ramirezmanuel longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution
AT diazmiguela longtermtransplantoutcomesafterallogeneichematopoietictransplantinpediatricpatientswithhematologicalmalignanciesareinfluencedbyseverechronicgraftvshostdiseaseandimmunereconstitution