title: Characterization of acute graft-versus-host disease following reduced-intensity stem-cell transplantation from an HLA-identical related donor.
abstract: To investigate clinical features of acute graft-versus-host disease (GVHD) following reduced intensity stem-cell transplantation (RIST), we retrospectively investigated medical records of 65 patients with hematologic malignancies who underwent RIST from a matched related donor. Preparative regimen comprised fludarabine 30 mg/m(2) (n = 53) or cladribine 0.11 mg/kg (n = 12) for 6 days plus busulfan 4 mg/kg for 2 days. Twelve patients received rabbit antithymocyte globulin 2.5 mg/kg/day for 2-4 consecutive days. Grade II to IV acute GVHD was diagnosed in 36 patients (55%). Its median onset was day 58 (range, 17-109), while it was bimodal, peaking day 15-29 (early-onset GVHD, n = 18) and day 75-89 days (late-onset GVHD, n = 18). Variables that were more common in early-onset GVHD than late-onset GVHD included skin rash (89% vs. 61%) and noninfectious fevers (33% vs. 11%). Desaturation, pulmonary infiltrates and hyperbilirubinemia (>2.0 mg/dL) were more common in late-onset GVHD (6% vs. 22%, 0% vs. 17%, and 6% vs. 33%, respectively). All of the patients with early-onset GVHD given corticosteroid responded to it, while 5 of the 18 patients with late-onset GVHD failed to respond it. Patients with either early-onset or late-onset GVHD tended to have better progression-free survival (PFS) than those without it; however, there was no significant difference in PFS between patients with early-onset GVHD and those with late-onset GVHD. This study suggests that several etiologies might have contributed to the development of acute GVHD following RIST.
authors.affiliation: Hematopoietic Stem Cell Transplantation Unit, The National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Murashige
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Shin-ichiro
authors.initials: S
authors.lastname: Mori
authors.forename: Yuta
authors.initials: Y
authors.lastname: Katayama
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Onishi
authors.forename: Akiko
authors.initials: A
authors.lastname: Hori
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Kishi
authors.forename: Tamae
authors.initials: T
authors.lastname: Hamaki
authors.forename: Kinuko
authors.initials: K
authors.lastname: Tajima
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Ryuji
authors.initials: R
authors.lastname: Tanosaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Takaue
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002066:Busulfan / Q000627:therapeutic use; D017338:Cladribine / Q000627:therapeutic use; D018572:Disease-Free Survival; D005190:Family; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D006680:HLA Antigens; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D000961:Antilymphocyte Serum; D006680:HLA Antigens; D017338:Cladribine; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine