title: Serious graft-versus-host disease after hematopoietic cell transplantation following nonmyeloablative conditioning.
abstract: The efficacy of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning depends on the balance between the desirable antineoplastic effects of donor cells weighed against the undesirable morbidity of graft-versus-host disease (GVHD). Development of serious acute or chronic GVHD was analyzed retrospectively in 171 consecutive patients, who had related or unrelated nonmyeloablative HCT for hematologic malignancies. GVHD was defined as serious when it resulted in (1) death, (2) disability, (3) three or more major infections in 1 year, (4) prolonged hospitalization or (5) suicide or hospitalization for suicidal ideation. According to this definition, 43 of 171 (25%) patients developed serious GVHD with a median follow-up of 30 (range, 12-65) months. The incidence of serious GVHD was similar after related and unrelated HCT. Among the 43 patients with serious GVHD, 20 had grade III-IV acute GVHD, and 30 had extensive chronic GVHD. Among the 171 patients, seven had grade III acute GVHD and 84 had extensive chronic GVHD that did not meet criteria for serious GVHD. Assessment of serious GVHD provides additional useful information to acute GVHD grades and classification of limited and extensive chronic GVHD in describing the overall risk and impact complications caused by donor cells.
authors.affiliation: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Department of Medicine, University of Washington, Seattle, WA, USA. mflowers@fhcrc.org
authors.forename: M E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: F
authors.initials: F
authors.lastname: Traina
authors.forename: B
authors.initials: B
authors.lastname: Storer
authors.forename: M
authors.initials: M
authors.lastname: Maris
authors.forename: W A
authors.initials: WA
authors.lastname: Bethge
authors.forename: P
authors.initials: P
authors.lastname: Carpenter
authors.forename: F
authors.initials: F
authors.lastname: Appelbaum
authors.forename: R
authors.initials: R
authors.lastname: Storb
authors.forename: B M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: P J
authors.initials: PJ
authors.lastname: Martin
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007239:Infections; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013405:Suicide; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods