An ethnic role for chronic, but not acute, graft-versus-host disease after HLA-identical sibling stem cell transplantation.
Among 424 HLA identical siblings undergoing stem cell transplantation, 364 were Scandinavians and 60 represented other ethnic groups. The cumulative probabilities of acute graft-versus-host disease grades II-IV were similar in both groups, 17% in Scandinavians and 12% in the others, p = 0.4. In a multivariate analysis, less effective immune suppression with cyclosporine or methotrexate alone (p = 0.001), recipient seropositive for three to four herpes viruses (p = 0.004), CMV-seropositive recipient (p = 0.05) and early engraftment (before day 15) (p = 0.05) were independent risk-factors for acute GVHD grades II-IV. The cumulative probabilities of chronic GVHD were 47% and 68% in the two ethnic populations, respectively (p = 0.004). In multivariate analysis, higher patient age (p < 0.001), non-Scandinavian population (p < 0.001) and immunised female donor to male recipient (p = 0.03) were independent risk factors for chronic GVHD. The higher incidence of chronic GVHD could not be explained by differences in HLA antigen frequencies. The cumulative probabilities of relapse were 37% in the both groups. This suggests that the Scandinavian population is more homogeneous with regard to minor histocompatibility antigens important for chronic, but not acute GVHD.
Remberger
M
M
Centre for Allogeneic Stem Cell Transplantation, and Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Sweden. Mats.Remberger@impi.ki.se
Aschan
J
J
Lönnqvist
B
B
Carlens
S
S
Gustafsson
B
B
Hentschke
P
P
Klaesson
S
S
Mattsson
J
J
Ljungman
P
P
Ringdén
O
O
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000349:Africa / Q000208:ethnology; D000368:Aged; D000741:Anemia, Aplastic / Q000628:therapy; D001208:Asia / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003587:Cytomegalovirus / Q000254:growth & development; D003586:Cytomegalovirus Infections / Q000208:ethnology / Q000209:etiology; D005060:Europe / Q000208:ethnology; D005199:Fanconi Anemia / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000208:ethnology* / Q000209:etiology / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006648:Histocompatibility; D006801:Humans; D015994:Incidence; D007223:Infant; D015993:Life Tables; D016015:Logistic Models; D008297:Male; D008661:Metabolism, Inborn Errors / Q000628:therapy; D008875:Middle Aged; D015778:Minor Histocompatibility Antigens / Q000276:immunology; D015999:Multivariate Analysis; D009369:Neoplasms / Q000628:therapy; D009679:Nuclear Family; D012008:Recurrence; D012307:Risk Factors; D012537:Scandinavian and Nordic Countries / Q000208:ethnology; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D014775:Virus Activation
D006680:HLA Antigens; D015778:Minor Histocompatibility Antigens