Risk factors for acute graft‐versus‐host disease

Abstract

Acute graft-versus-host disease (GvHD) is an important complication of bone marrow transplantation in humans. Risk factors are imprecisely defined and controversial. We analysed data from 2036 recipients of HLA-identical sibling transplants for leukaemia or aplastic anaemia to identify risk factors for GvHD. Analyses indicate that grading of GvHD can be reproducibly divided into absent or mild versus moderate to severe; 2-year actuarial probability was 54% (95% confidence interval 52-56%) for absent or mild and 46% (44-48%) for moderate to severe. Factors predictive of development of moderate to severe GvHD include donor/recipient sex-match (female----male greater than others, relative risk 2.0, P less than 0.001). This risk was markedly increased if female donors for male recipients were previously pregnant or transfused (relative risk 2.9, P less than 0.0001). Older patients were at increased risk of GvHD (relative risk 1.6, P less than 0.001), but the age gradient was modest, even the youngest patients had a substantial risk of GvHD and, if parous or transfused female----male transplants were excluded, age was not a significant risk factor. Cyclosporine or methotrexate were equally effective at preventing GvHD and were superior to no prophylaxis (relative risk 2.3, P less than 0.01). These data should be useful in estimating the risk of acute GvHD in an individual patient and in designing clinical trials to investigate methods to modify or prevent GvHD.

Donor–recipient gender difference affects severity of dry eye after hematopoietic stem cell transplantation

“…These findings are consistent with previous reports on the severity of systemic GVHD, in which male HSCT recipients of female donor tissue had a significantly higher probability of developing systemic GVHD compared with the recipients of other recipient-donor gender combinations. [6][7][8][9] These results indicate that dry eye well reflects systemic cGVHD, suggesting that dry eye could be a hallmark of cGVHD based on the assessment of dry eye parameters compared with pre-BMT (Figure 1). There was no difference in the overall incidence of dry eye among the four groups.…”

“…5 In particular, GVHD in male recipients of female donors tends to be especially severe. [6][7][8][9] Given the current knowledge about gender mismatch and GVHD, it seems likely that HSCT with a female donor and male recipient could increase the patient's risk of developing cGVHD-related severe dry eye. However, no report on donor-recipient gender mismatch affecting ocular GVHD has been published in the ophthalmologic literature.…”

Monitoring soluble interleukin-2 receptor levels in related and unrelated donor allogeneic bone marrow transplantation

“…1 GVHD occurs in 50% of HLA-identical sibling transplants and in up to 80% of matched unrelated transplants. 2,3 GVHD is graded according to the extent and pattern of organ involvement (skin, liver and gut). 4 Pathology in acute GVHD involves immunocompetent donor T lymphocytes which have been activated during myeloablative therapy.…”

Prophylaxis of graft-versus-host disease with cyclosporine–prednisone is associated with increased risk of chronic graft-versus-host disease

“…Moderate-to-severe GVHD occurs in as many as one-half of the recipients of HLA-identical sibling transplants despite post-transplantation prophylaxis of GVHD. 2 Chronic GVHD develops in a significant number of these patients. For patients who survive the initial 2 to 3 months after transplantation, development of chronic GVHD has the greatest effect on their subsequent quality of life.…”