Risk factors for chronic graft-versus-host disease after HLA-identical sibling bone marrow transplantation

Abstract

Chronic graft-versus-host disease (GVHD) is an important complication of bone marrow transplantation. We analyzed risk factors for chronic GVHD in 2,534 recipients of HLA-identical sibling transplants surviving at least 90 days after transplantation. The actuarial probability of developing chronic GVHD within three years posttransplant was 46% +/- 3% (95% confidence interval). The most important risk factor for chronic GVHD was acute GVHD. The 3-year probabilities of chronic GVHD were 28% +/- 3%, 49% +/- 5%, 59% +/- 6%, 80% +/- 9%, and 85% +/- 15% for persons with grades 0, I, II, III, and IV acute GVHD, respectively (P less than .0001). Among patients with no or grade I acute GVHD, recipient age greater than 20 years, use of non-T-cell depleted bone marrow, and alloimmune female donors for male recipients predicted a higher risk of chronic GVHD. When all three adverse risk factors were present, the probability of chronic GVHD was 62% among persons with no prior acute GVHD and 85% among those with grade I acute GVHD. Among patients with grade II through IV acute GVHD, no other risk factor predicted chronic GVHD. These data identify individuals who might benefit from treatment strategies aimed at changing the incidence of chronic GVHD.

GVHD prophylaxis using low‐dose cyclosporine improves survival in leukaemic recipients of HLA‐identical sibling transplants

“…We here report increased risks of acute GVHD grades I-II as well as chronic GVHD using low-dose CsA as GVHD prophylaxis. The physiological phenomenon underlying the increased incidence of both acute and chronic GVHD using low CsA is most likely similar; however, it is important to note that acute GVHD, as reported in the present study, may not be a major risk factor for chronic GVHD in recipients of HLA-identical sibling transplants (24), although some previous studies have shown a correlation between acute and chronic GVHD (28,29). When using the low-dose CsA regimen, approximately 25% of all patients still did not develop any acute GVHD.…”

Stem cell transplantation from HLA‐matched related donor for Fanconi's anaemia: a retrospective review of the multicentric Italian experience on behalf of Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP)–Gruppo Italiano Trapianto di Midollo Osseo (GITMO)

“…Acute GVHD was assessed in patients surviving more than 21 d following engraftment using published criteria (Glucksberg et al, 1974). Chronic GVHD was defined using clinical criteria in patients surviving more than 90 d following engraftment (Atkinson et al, 1990).…”

Immunomonitoring of graft‐versus‐host minor histocompatibility antigen correlates with graft‐versus‐host disease and absence of relapse after graft

“…14 In humans, the clinical relevance of mH antigens has been much more difficult to establish. The most important feature is the statistical demonstration of reduced risk of relapse in the case of sex mismatch (female donor, male recipient) as has been shown in retrospective series of allogeneic transplantation for leukemia [15][16][17] and in addition, a higher risk of GVHD. These statistical data were recently confirmed by a study demonstrating the direct association between mH antigen mismatch, GVHD, and relapse.…”