title: Chronic graft-versus-host disease after allogeneic bone marrow transplantation from an unrelated donor: incidence, risk factors and association with relapse. A report from the Japan Marrow Donor Program.
abstract: Chronic graft-versus-host disease (GVHD) remains the major cause of late morbidity and mortality after allogeneic stem cell transplantation. We retrospectively analysed 2937 patients who underwent bone marrow transplantation from an unrelated donor (UR-BMT) facilitated by the Japan Marrow Donor Program (JMDP) and survived beyond day 100 after transplantation. The cumulative incidence of chronic GVHD (limited + extensive) or extensive chronic GVHD at 5 years post-transplant was 45.8% and 28.2%, respectively. On multivariate analysis, seven variables predicting chronic GVHD were identified: recipient age over 20 years, donor age over 30 years, primary diagnosis of chronic myeloid leukaemia, human leucocyte antigen (HLA)-A or -B mismatch, total body irradiation-containing regimen, platelet count not having reached 50 x 10(9)/l by day 100, and prior acute GVHD. Among 2609 patients with haematological malignancy, overall survival was significantly higher in patients with limited chronic GVHD but lower in patients with extensive chronic GVHD compared with those without chronic GVHD. The cumulative incidence of relapse among patients with limited or extensive chronic GVHD was significantly lower than that among patients without chronic GVHD. Our results suggest that limited chronic GVHD provides a survival benefit to patients with haematological malignancies by reducing the risk of relapse without increasing the risk of death from chronic GVHD.
authors: Division of Haematology, Department of Clinical Cell Biology, Chiba University Graduate School of Medicine, Chiba, Japan.
authors: Shinichi
authors: S
authors: Ozawa
authors: Chiaki
authors: C
authors: Nakaseko
authors: Miki
authors: M
authors: Nishimura
authors: Atsuo
authors: A
authors: Maruta
authors: Ryuko
authors: R
authors: Cho
authors: Chikako
authors: C
authors: Ohwada
authors: Hisashi
authors: H
authors: Sakamaki
authors: Hiroshi
authors: H
authors: Sao
authors: Shin-ichiro
authors: S
authors: Mori
authors: Shinichiro
authors: S
authors: Okamoto
authors: Kouichi
authors: K
authors: Miyamura
authors: Shunichi
authors: S
authors: Kato
authors: Takakazu
authors: T
authors: Kawase
authors: Yasuo
authors: Y
authors: Morishima
authors: Yoshihisa
authors: Y
authors: Kodera
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000209:etiology; D019337:Hematologic Neoplasms / Q000628:therapy; D006650:Histocompatibility Testing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index