The incidence and risk factors for chronic graft-versus-host-disease.
OBJECTIVE
Chronic graft-versus-host-disease (cGVHD) deteriorates survival and quality of life after allogeneic hematopoietic cell transplantation (alloHCT). We evaluated the incidence and risk factors for this complication based on a single-center experience.


METHODS
255 consecutive patients, aged 29 (10-56) years, who survived without disease progression after alloHCT performed between 1992-2003 were included in the analysis. The preparative regimen was myeloablative, donors were either related (n=177) or unrelated volunteers (URD-HCT) (n=78).


RESULTS
Cumulative incidence of the overall and extensive cGVHD equaled 48% and 22%, respectively. In a multivariate analysis the following factors were associated with increased risk of cGVHD: preceding grade II-IV acute GVHD, recipient age > or =40 years, URD-HCT, the diagnosis of chronic myeloid leukemia (CML) or myelodysplastic syndrome, and CD3 cell dose 50 x 10(6)/kg. Similar factors, excluding recipient age contributed to increased risk of extensive cGVHD, however, the cut-point for CD3 cell dose was 100 x l0(6)/kg and the use of steroids for acute GVHD prophylaxis was found an additional risk factor. In a CML subgroup the risk of cGVHD was increased for patients previously treated with interferon.


CONCLUSIONS
Various recipient-, donor-, and procedure-related factors are related to the risk of cGVHD. Individualized treatment and modification of risk factors may contribute to improved outcome.
Wojnar
Jerzy
J
Dept. of Haematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland. klinhem@slam.katowice.pl
Giebel
Sebastian
S
Holowiecka-Goral
Aleksandra
A
Krawczyk-Kulis
Małgorzata
M
Markiewicz
Miroslaw
M
Wozniczka
Krzysztof
K
Holowiecki
Jerzy
J
D000293:Adolescent; D000328:Adult; D002648:Child; D002908:Chronic Disease; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000628:therapy; D019520:Living Donors; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000706:statistics & numerical data