Impact of graft-versus-host disease on relapse and survival after allogeneic stem cell transplantation for pediatric leukemia

Bone Marrow Transplant. 2019 Jan;54(1):68-75. doi: 10.1038/s41409-018-0221-6. Epub 2018 May 24.


Graft-versus-host disease (GVHD) occasionally leads to morbidity and mortality but is thought to reduce the risk of relapses in patients with a hematological malignancy. However, information on the effect of GVHD in pediatric leukemia is limited. Using a nationwide registry, we retrospectively analyzed 1526 children who underwent allogeneic stem cell transplantation for leukemia. Grades 0-I acute GVHD were associated with a higher relapse rate at three years after transplantation, at 25.4 and 24.3%, respectively, than grades II, III, or IV acute GVHD at 18.9%, 21.2%, and 2.6%, respectively. In contrast, the overall survival curve of the grades 0 and I GVHD groups (79.0% and 79.5%, respectively) approximated that of the grade II GVHD group (76.3%), and the probability of survival was worst in the severe GVHD groups (66.9% for grade III and 42.5% for grade IV). Chronic GVHD also reduced the relapse risk but conferred no survival advantage. Acute lymphoblastic leukemia was more sensitive to acute GVHD than acute myeloid leukemia (AML) while AML was more sensitive to chronic GVHD. Our study reproduced the preventive effects of GVHD against pediatric leukemia relapses but failed to demonstrate a significant survival advantage.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Allografts
  • Child
  • Child, Preschool
  • Chronic Disease
  • Disease-Free Survival
  • Female
  • Graft vs Host Disease* / mortality
  • Graft vs Host Disease* / prevention & control
  • Hematologic Neoplasms / mortality
  • Hematologic Neoplasms / therapy
  • Humans
  • Infant
  • Infant, Newborn
  • Leukemia* / mortality
  • Leukemia* / therapy
  • Male
  • Recurrence
  • Stem Cell Transplantation*
  • Survival Rate