title: Allogeneic peripheral blood stem cell transplantation may be associated with a high risk of chronic graft-versus-host disease.
abstract: Chronic graft-versus-host disease (GVHD) is likely caused by donor T lymphocytes. Because unmodified blood stem cell grafts contain one log more T lymphocytes than unmodified marrow grafts, we evaluated the incidence of chronic GVHD in previously reported 37 blood stem cell recipients and 37 computer-matched historical control marrow recipients (Bensinger et al, Blood 88:2794, 1996). All patients have been followed until death, relapse, or occurrence of chronic GVHD or for a minimum of 2 years. In a univariable proportional hazards regression model, the relative risk of developing clinical chronic GVHD (includes clinical limited and clinical extensive disease) by 2 years posttransplant among the peripheral blood stem cell recipients compared with the marrow recipients was 2.22 (95% confidence interval, 1.04 to 4.74; P = .039). For clinical extensive chronic GVHD, the relative risk was 2.37 (95% confidence interval, 1.07 to 5. 29; P = .035). In multivariable analyses, considering also the covariables of patient age, patient cytomegalovirus serostatus, and donor cytomegalovirus serostatus, the relative risks of clinical chronic GVHD and clinical extensive chronic GVHD were also greater than 2 (P < .05). We conclude that the transplantation of unmanipulated filgrastim-mobilized blood stem cells may result in a relatively high incidence of chronic GVHD.
authors.affiliation: Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA 98104-2092, USA.
authors.forename: J
authors.initials: J
authors.lastname: Storek
authors.forename: T
authors.initials: T
authors.lastname: Gooley
authors.forename: M
authors.initials: M
authors.lastname: Siadak
authors.forename: W I
authors.initials: WI
authors.lastname: Bensinger
authors.forename: D G
authors.initials: DG
authors.lastname: Maloney
authors.forename: T R
authors.initials: TR
authors.lastname: Chauncey
authors.forename: M
authors.initials: M
authors.lastname: Flowers
authors.forename: K M
authors.initials: KM
authors.lastname: Sullivan
authors.forename: R P
authors.initials: RP
authors.lastname: Witherspoon
authors.forename: S D
authors.initials: SD
authors.lastname: Rowley
authors.forename: J A
authors.initials: JA
authors.lastname: Hansen
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: F R
authors.initials: FR
authors.lastname: Appelbaum
mesh_terms: D002908:Chronic Disease; D006086:Graft vs Host Disease / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D012306:Risk; D013601:T-Lymphocytes / Q000276:immunology; D014184:Transplantation, Homologous