Risk factors for moderate-to-severe acute graft-vs.-host disease after allogeneic stem cell transplantation in children.
Severe acute graft-vs.-host disease (aGVHD) remains a major cause of transplantation-related mortality. However, because of a graft-vs.-leukaemia effect, a mild (grade I) aGVHD is desirable. As risk factors predisposing for aGVHD are not necessarily the same in children and adults, we have performed a retrospective analysis of risk factors (RFs) for grade II-IV aGVHD in 258 paediatric patients undergoing allogeneic stem cell transplantation at our centre. Thirty-two potential RFs were assessed with univariate analysis in logistic regression. Eleven factors were selected for further evaluation in stepwise elimination multivariate analysis. Three independent RFs were found: (1) donor other than human lekocyte antigen (HLA)-identical sibling [odds ratio (OR) 6.1, p < 0.001); (2) single drug [cyclosporine A (CsA) or methotrexate (Mtx)] graft-vs.-host disease (GVHD) prophylaxis (OR 7.0, p < 0.001); and (3) ABO disparity of any kind (OR 2.4, p = 0.02). The RFs were additive: moderate-to-severe aGVHD was seen in none of the patients without any RFs; in 16% with one RF; in 32% with two RFs and in 67% with all three RFs present. Single drug GVHD prophylaxis (CsA or Mtx), any kind of ABO mismatch, and non-sibling donors are RFs for grade II-IV acute GVHD in paediatric SCT. We encourage the use of combination GVHD prophylaxis in children. ABO mismatch should be considered when choosing between otherwise equally suitable donors.
Svennilson
Johan
J
Centre for Allogeneic Stem Cell Transplantation, and Paediatric Haematology Unit, Huddinge University Hospital, Stockholm, Sweden. johan.svennilson@klinvet.ki.se
Remberger
Mats
M
Ringdén
Olle
O
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014184:Transplantation, Homologous