Characterization of acute graft‐versus‐host disease following reduced‐intensity stem‐cell transplantation from an HLA‐identical related donor

Abstract

To investigate clinical features of acute graft-versus-host disease (GVHD) following reduced intensity stemcell transplantation (RIST), we retrospectively investigated medical records of 65 patients with hematologic malignancies who underwent RIST from a matched related donor. Preparative regimen comprised fludarabine 30 mg/m 2 (n 5 53) or cladribine 0.11 mg/kg (n 5 12) for 6 days plus busulfan 4 mg/kg for 2 days. Twelve patients received rabbit antithymocyte globulin 2.5 mg/kg/day for 2-4 consecutive days. Grade II to IV acute GVHD was diagnosed in 36 patients (55%). Its median onset was day 58 (range, 17-109), while it was bimodal, peaking day 15-29 (early-onset GVHD, n 5 18) and day 75-89 days (late-onset GVHD, n 5 18). Variables that were more common in early-onset GVHD than late-onset GVHD included skin rash (89% vs. 61%) and noninfectious fevers (33% vs. 11%). Desaturation, pulmonary infiltrates and hyperbilirubinemia (>2.0 mg/dL) were more common in late-onset GVHD (6% vs. 22%, 0% vs. 17%, and 6% vs. 33%, respectively). All of the patients with early-onset GVHD given corticosteroid responded to it, while 5 of the 18 patients with late-onset GVHD failed to respond it. Patients with either early-onset or late-onset GVHD tended to have better progression-free survival (PFS) than those without it; however, there was no significant difference in PFS between patients with early-onset GVHD and those with late-onset GVHD. This study suggests that several etiologies might have contributed to the development of acute GVHD following RIST. Am. J. Hematol. 83:630-634, 2008. V

Methotrexate dose delivery is more important than ciclosporin level in graft-versus-host disease prophylaxis following T-replete reduced-intensity sibling allogeneic stem cell transplant

“…With regard to aGvHD, we found a GIT rather than skin to be the most frequently affected site; this differs from the findings following MAC HSCT where skin is the most frequently affected site [31]. Relatively few studies have described the tissue site of GvHD in detail following RIC HSCT, but following purine analogue-based conditioning aGvHD is reported to affect the skin in 58-75% and GIT in 50-56% of cases [9,10,32]. Thus, we report a slightly higher incidence of GIT GvHD with a relatively reduced incidence of cutaneous GvHD.…”

A single nucleotide polymorphism of IL-17 gene in the recipient is associated with acute GVHD after HLA-matched unrelated BMT

“…note, the validation study has demonstrated the association between the recipient 197A genotype and the increased incidence of chronic GVHD. This might reflect the association between the recipient 197A genotype and the risk of late acute GVHD, 49 considering that late acute GVHD occurs frequently after nonmyeloablative conditioning transplantation 50 and that the manifestation of late acute GVHD is usually indistinguishable from chronic GVHD. 51 In this study, the diagnosis of chronic GVHD was based on historical criteria, 45 and data on chronic GVHD classification according to the new NIH criteria 49 were unavailable, thus suggesting that late-onset, prolonged or delayed acute GVHD could have been diagnosed as chronic GVHD.…”

Enfermedad de injerto cutáneo contra huésped

“…Se ha encontrado que, entre hermanos con HLA idéntico que reciben un trasplante alogénico, la incidencia de la enfermedad aguda es mucho más baja, alrededor del 20 %, que entre aquellos que reciben varios injertos no relacionados 12,13 . La incidencia de enfermedad aguda de injerto contra huésped de grado III/IV es de 30 % en donantes no relacionados con HLA idéntico, de 40 % en aquellos con una disparidad en uno o dos alelos de la clase I, especialmente HLA-A, y de, aproximadamente, 33 % cuando se trata de trasplantes de familiares pero con disparidad en uno o dos alelos [14][15][16] . Figura 1.…”