Prognostic factors of chronic graft-versus-host disease after allogeneic blood stem-cell transplantation.
Allogeneic hematopoietic stem cells in peripheral blood transplantation (alloPBSCT) or bone marrow transplantation (alloBMT) have different biological characteristics which may affect differently prognostic factors for incidence and severity of chronic graft-versus-host disease (cGVHD). To determine the prognostic factors of cGVHD in patients receiving alloPBSCT, data on 87 patients who survived at least 100 days after matched related donor myeloablative transplantation were analyzed. Factors significantly associated with higher incidence of cGVHD after alloPBSCT included CMV-positive donor, acute skin GVHD, and diagnoses other than lymphoma. Factors predictive for poor survival following cGVHD diagnosis included platelet count < 100,000/mm3 and history of acute liver GVHD. Acute liver GVHD and etoposide in the preparative regimen significantly increased risk of death due to cGVHD after alloPBSCT. All alloPBSCT multivariate models were fit to an independent cohort of comparable matched related donor alloBMT patients (n=75). After alloBMT, only acute skin GVHD and diagnoses other than lymphoma retained prognostic significance for predicting cGVHD. Low platelet count was the only variable predictive for poor survival in cGVHD patients after alloBMT. Acute liver GVHD was the only factor that retained prognostic significance for risk of death due to cGVHD after alloBMT. These data suggest there are some cGVHD prognostic factors that may be unique to recipients of alloPBSCT. More studies are needed to determine whether cGVHD prognostic systems should be used interchangeably in patient populations receiving different stem-cell products.
Pavletic
Steven Z
SZ
Department of Internal Medicine, Section of Oncology-Hematology, University of Nebraska Medical Center, Omaha, Nebraska, USA. pavletis@mail.nih.gov
Smith
Lynette M
LM
Bishop
Michael R
MR
Lynch
James C
JC
Tarantolo
Stefano R
SR
Vose
Julie M
JM
Bierman
Philip J
PJ
Hadi
Abdul
A
Armitage
James O
JO
Kessinger
Anne
A
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D011379:Prognosis; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D016019:Survival Analysis; D014184:Transplantation, Homologous