470 Analysis of Risk Factors for Hepatic Acute Graft-Versus-Host Disease By Using Transplant Registry Data in Japan

Track: Poster Abstracts
Saturday, February 14, 2015, 6:45 PM-7:45 PM
Grand Hall CD (Manchester Grand Hyatt)
Yasuyuki Arai, MD , Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Junya Kanda, MD , Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Hideki Nakasone , Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
Tadakazu Kondo, MD , Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Naoyuki Uchida, MD, PhD , Department of Hematology, Toranomon Hospital, Tokyo, Japan
Takahiro Fukuda, MD, PhD , Stem Cell Transplantation Division, National Cancer Center Hospital, Tokyo, Japan
Kazuteru Ohashi , Division of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
Hiroyasu Ogawa, MD, PhD , Division of Hematology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
Tokiko Nagamura-Inoue, MD , Department of Cell Processing and Transfusion, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
Yasuo Morishima, MD , Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
Makoto Hirokawa, MD , Department of General Internal Medicine and Clinical Laboratory Medicine, Graduate School of Medicine, Akita University, Akita, Japan
Yoshiko Atsuta, MD, PhD , Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
Makoto Murata, MD , Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
Presentation recording not available for download or distribution as requested by the presenting author.

Background

Various risk factors of aGVHD have already been identified. However, organ-specific risk factors are yet to be known, especially for hepatic aGVHD, which often induces SCT-related mortality. Therefore, we conducted a retrospective cohort study to determine whether pre-transplant hepatic conditions are related to hepatic aGVHD after allo-SCT by using a Japanese transplant registry database.

Patients and Methods

We included adult patients with hematopoietic malignancies who underwent initial allo-SCT between 2008 and 2012 in Japan. From the registry database, we extracted the data on pre-transplant hepatic conditions, such as hepatic dysfunction (elevation of AST/ALT and/or T-Bil levels), hepatitis viral infection (HBs antigens and/or HCV antibodies), and previous history of massive erythrocyte transfusions (≥ 20 packs). Univariate analyses of the cumulative incidence of hepatic aGVHD (≥ stage 1) were performed using Gray's methods, considering early death and relapse as competitive risks. Fine and Gray's proportional hazards models were used to adjust for other confounders such as donor sources and conditioning regimens.

Results

We evaluated 8,378 patients aged 16 to 80 years (median, 49 years). Underlying diagnoses included AML (46.3%), ALL (19.1%), MDS (12.3%), and NHL (10.9%). Disease status at SCT was progressive in 48.6% of the patients, and conditioning regimens were myeloablative in 30.2%. Donor sources included UR-BM (46.1%), Rel-PB (21.0%), single CBT (19.7%), and Rel-BM (13.2%). HLA was matched in 58.0%. As aGVHD prophylaxis, tacrolimus were used in 61.2%. The HBs antigen and HCV antibody were positive in 3.5% and 1.5%, respectively. Pre-transplant hepatic dysfunction was observed in 9.4%. The cumulative incidence of hepatic aGVHD after SCT was 6.7% (95%CI, 6.2 - 7.3%; Figure 1), and overall survival was poorer in the patients with hepatic aGVHD complications (time-dependent covariant analyses; hazard ratio [HR], 2.98; p < 0.01). The multivariate analyses showed that hepatic dysfunction (HR, 1.85; p < 0.01) and HCV antibody positivity (HR, 1.93; p = 0.02) were significant risk factors of hepatic aGVHD (Figure 2) and that hepatic dysfunction due to HCV infection conferred an especially higher risk (HR, 6.87; p < 0.01). These factors were specific for hepatic aGVHD, and not significant for skin or gut aGVHD. HBs antigens (HR, 0.64; p = 0.13) and massive erythrocyte transfusions (HR, 1.08; p = 0.44) were not significant, whereas SCT at progressive disease, Rel-PB or UR-BM, HLA mismatch, and use of cyclosporine A as aGVHD prophylaxis were significant risk factors of hepatic aGVHD.

Discussion and Conclusion

This study suggests that chronic inflammation and injury of liver before SCT can induce aGVHD. Modification of aGVHD prophylaxis and early intervention may improve the prognosis of patients with high-risk factors such as those indicated in this study.

 

Disclosures:
Nothing To Disclose
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