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Type: Artigo de periódico
Title: Treatment Change as a Predictor of Outcome among Patients with Classic Chronic Graft-versus-Host Disease
Author: Flowers, MED
Storer, B
Carpenter, P
Rezvoni, AR
Vigorito, AC
Campregher, PV
Moravec, C
Kiem, HP
Fero, M
Georges, G
Warren, E
Lee, S
Sanders, JE
Appelbaum, F
Martin, PJ
Abstract: We analyzed outcomes for 668 patients who had systemic treatment for chronic graft-versus-host disease (cGVHD) to assess the utility of early treatment change for exacerbation of cGVHD as a surrogate for survival endpoints in clinical trials. Fifty-six percent of patients had treatment change within 2 years after diagnosis of cGVHD. The median onset of treatment change was 4.4 months (range: 0.3-50 months). The cumulative incidence of nonrelapse mortality (NRM) at 2 years was 16%, and overall survival (OS) at 2 years was 74%. In time-dependent Cox models, treatment change was associated with an increase in risk of NRM (hazard ratio, 2.53; 95% confidence interval, 1.7-3.7; P < .0001). The hazard ratio was attenuated by 6% per month of delay in treatment change. Our results confirm that exacerbation of cGVHD is associated with an increased risk of NRM and with decreased OS, but the strength of this association is not large enough to allow the use of early exacerbation as a surrogate for survival endpoints in clinical trials. Other measures of clinical benefit, such as response, will need to be developed as endpoints in phase 11 trials for patients with cGVHD.
Subject: Chronic graft-versus-host disease
Country: EUA
Editor: Elsevier Science Inc
Citation: Biology Of Blood And Marrow Transplantation. Elsevier Science Inc, v. 14, n. 12, n. 1380, n. 1384, 2008.
Rights: fechado
Identifier DOI: 10.1016/j.bbmt.2008.09.017
Date Issue: 2008
Appears in Collections:Unicamp - Artigos e Outros Documentos

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