title: 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.
authors.affiliation: International Bone Marrow Transplant Registry, Medical College of Wisconsin, Milwaukee 53226.
authors.forename: K
authors.initials: K
authors.lastname: Atkinson
authors.forename: M M
authors.initials: MM
authors.lastname: Horowitz
authors.forename: R P
authors.initials: RP
authors.lastname: Gale
authors.forename: D W
authors.initials: DW
authors.lastname: van Bekkum
authors.forename: E
authors.initials: E
authors.lastname: Gluckman
authors.forename: R A
authors.initials: RA
authors.lastname: Good
authors.forename: N
authors.initials: N
authors.lastname: Jacobsen
authors.forename: H J
authors.initials: HJ
authors.lastname: Kolb
authors.forename: A A
authors.initials: AA
authors.lastname: Rimm
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
mesh_terms: D000208:Acute Disease; D016026:Bone Marrow Transplantation / Q000276:immunology*; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D006680:HLA Antigens / Q000276:immunology; D006648:Histocompatibility; D006801:Humans; D007938:Leukemia / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D012801:Sibling Relations
chemical_list: D006680:HLA Antigens