Abstract
Background: Although it has been reported that the incidence of acute GVHD (aGVHD) and early non-relapse mortality (NRM) after HLA-identical sibling BMT are different between Japanese and other ethnicities, including white American, African American and Irish populations (Oh, Blood.2005), there has been no previous comparison among Asian countries.
Patients and Methods: We retrospectively surveyed the data of 1933 patients (pts) (996 Korean and 937 Japanese) who underwent allo-Tx for leukemia or MDS between Jan, 2000 and Dec, 2005. The median age of the pts was 37 yrs (range, 16–70; 34 yrs vs 43 yrs, respectively) and the median follow-up of surviving pts was 1046 days (11–2435). Unexpectedly, the pts’ backgrounds, including age, underlying disease, disease status at Tx, stem cell source, donor type, No. of HLA-mismatched (MM) antigen/allele, conditioning regimen, in vivo T-cell depletion with ATG or Campath-1H and GVHD prophylaxis were significantly different between the two groups.
Results: (Table) In a multivariate analysis, Tx from a serologically HLA-1-antigen MM donor, Tx from an unrelated donor (URD), pts with high-risk disease at Tx, no in vivo T-cell depletion and a conditioning regimen that included TBI ≥ 10 Gy were associated with an increased risk of grade II–IV aGVHD. Overall, race was not a risk factor for grade II–IV (P=0.19) or III–IV (P=0.98) aGVHD. The incidence of chronic GVHD (cGVHD) in Japanese was significantly lower than that in Korean (P=0.016). In a multivariate analysis, Tx from a genetically HLA-allele MM donor, Tx from an URD, pts with performance status 2–4 at Tx, pts with high-risk disease at Tx, pts with ALL, female to male Tx and pts’ age ≥ 40 yrs were associated with poor OS. Race was not a risk factor for OS. The incidence of relapse adjusted for the underlying disease status was associated with grade II–IV aGVHD (RR 0.75, 95% CI 0.61–0.94, P=0.010), but not cGVHD (P=0.63).
Conclusions: Despite their different medical backgrounds, our data confirmed that the biology of GVHD is very similar between these two Asian populations, and this provides a uniform foundation for large-scale clinical studies in the region.
| . | Korean (n=996) . | Japanese (n=937) . |
|---|---|---|
| Grade II–IV/III–IV aGVHD | 37%/15% | 44%/19% |
| Median onset of aGVHD | day 28 | day 21 |
| cGVHD | 60% | 47% |
| 3-yr OS in standard/high risk | 70%/42% | 65%/41% |
| NRM | 25% | 30% |
| Relapse | 25% | 24% |
| . | Korean (n=996) . | Japanese (n=937) . |
|---|---|---|
| Grade II–IV/III–IV aGVHD | 37%/15% | 44%/19% |
| Median onset of aGVHD | day 28 | day 21 |
| cGVHD | 60% | 47% |
| 3-yr OS in standard/high risk | 70%/42% | 65%/41% |
| NRM | 25% | 30% |
| Relapse | 25% | 24% |
Author notes
Disclosure: No relevant conflicts of interest to declare.
