Acute graft-versus-host disease. The incidence and risk factors.
OBJECTIVE
Acute graft-versus-host-disease (aGvHD) is a major cause of mortality after allogeneic hematopoietic cell transplantation (alloHCT). The goal of this study was to evaluate the incidence and risk factors for this complication.


METHODS
330 consecutive patients (183 male and 147 female), aged 29 (10-56) years, treated with alloHCT in a single center between 1992-2003 were included in the analysis. AlloHCT was performed after myeloablative conditioning from either related donor (rel-HCT) (n=223) or unrelated voulnteer (URD-HCT) (n=107). GVHD prophylaxis consisted of cyclosporin, methotrexate +/- prednisolone.


RESULTS
Cumulative incidence of grade II-IV and grade III-IV aGvHD equaled 31% and 17%, respectively. In multivariate analysis the following factors were associated with increased risk of grade II-IV aGvHD: the diagnosis of chronic myeloid leukemia (CML) or myelodysplastic syndrome (MDS) (vs. other diagnoses), URD-HCT (vs. Rel-HCT), years of alloHCT 1992-2001 (vs. 2002-2003), donor age > or =35 years, and CD34+ cell dose > or = 4.0 x 10(6)/kg. Increased risk of grade III-IV aGVHD was associated with: the use of prednisolone for aGvHD prophylaxis, the diagnosis of CML or MDS, and CD3+ cell dose > or =100 x l0(6)/kg.


CONCLUSIONS
Incidence of aGvHD depends on various recipient-, donor-, and procedure-related factors. This should be taken into account when planning treatment for every individual patient.
Wojnar
Jerzy
J
Dept. of Haematology and Bone Marrow Transplantation, Silesian Medical University, Poland. klinhem@slam.katowice.pl
Giebel
Sebastian
S
Krawczyk-Kulis
Malgorzata
M
Markiewicz
Mirosław
M
Kruzel
Tomasz
T
Wylezol
Iwona
I
Czerw
Tomasz
T
Seweryn
Marek
M
Holowiecki
Jerzy
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007938:Leukemia / Q000628:therapy*; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous