Clinical benefit of response in chronic graft-versus-host disease - PubMed (original) (raw)

Multicenter Study

. 2012 Oct;18(10):1517-24.

doi: 10.1016/j.bbmt.2012.05.016. Epub 2012 Jun 6.

Paul J Martin, Xiaoyu Chai, Madan Jagasia, Jeanne Palmer, Joseph Pidala, Corey Cutler, Steven Z Pavletic, Mukta Arora, David Jacobsohn, Paul A Carpenter, Mary E D Flowers, Nandita Khera, Georgia B Vogelsang, Daniel Weisdorf, Barry E Storer, Stephanie J Lee; Chronic GVHD Consortium

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Multicenter Study

Clinical benefit of response in chronic graft-versus-host disease

Yoshihiro Inamoto et al. Biol Blood Marrow Transplant. 2012 Oct.

Abstract

To determine whether changes in objective response measures proposed by the National Institutes of Health correlate with clinical benefit, such as symptom burden, quality of life, and survival outcomes, we analyzed data from a multicenter prospective cohort of 283 patients with chronic graft-versus-host disease requiring systemic treatment. The median follow-up time of survivors was 25.1 months (range, 5.4-47.7 months) after enrollment. Symptom measures included the Lee symptom scale and 10-point patient-reported symptoms. Quality-of-life measures included the Short Form-36, Functional Assessment of Cancer Therapy-Bone Marrow Transplantation, and Human Activities Profile. Overall and organ-specific responses were calculated by comparing manifestations at the 6-month visit and those at the enrollment visit using a provisional algorithm. Complete or partial responses were considered "response," and stable or progressive disease was considered "no response." Overall response rate at 6 months was 32%. Organ-specific response rates were 45% for skin, 23% for eyes, 32% for mouth, and 51% for gastrointestinal tract. Response at 6 months, as calculated according to the provisional response algorithm, was correlated with changes in symptom burden in patients with newly diagnosed chronic graft-versus-host disease, but not with changes in quality of life or survival outcomes. Modification of the algorithm or validation of other more meaningful clinical endpoints is warranted for future clinical trials of treatment for chronic graft-versus-host disease.

Copyright © 2012 American Society for Blood and Marrow Transplantation. All rights reserved.

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Figures

Figure 1

Figure 1

Calculated response for overall and individual organs at 6 months after enrollment, according to the provisional algorithm. GI, gastrointestinal tract; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease.

Figure 2

Figure 2

Survival outcomes according to overall response at 6 months. (A) Overall survival. (B) Nonrelapse mortality. P values are derived from the adjusted Cox model.

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