title: Risk factors associated with increased nonrelapse mortality and with poor overall survival in children with chronic graft-versus-host disease.
abstract: There is a paucity of information regarding the factors that affect nonrelapse mortality (NRM) and overall survival among children that develop chronic graft-versus-host disease (cGVHD). We performed multivariate analyses using data from the Center for International Blood and Marrow Transplant Research to identify risk factors for NRM and survival in 1117 pediatric subjects with leukemia or myelodysplastic syndrome, transplanted from related donors, unrelated donors (URD), or unrelated cord blood between 1995 and 2004. We identified 4 variables associated with higher NRM: HLA partially matched or mismatched URD, peripheral blood cell graft, Karnofsky/Lansky score < 80 at cGVHD diagnosis, and platelets < 100 × 10(9)/L at cGVHD diagnosis. Factors associated with significantly worse survival were: age > 10 years, transplantation from HLA partially matched or mismatched URD, advanced disease at transplantation, Karnofsky/Lansky < 80; and platelets < 100 × 10(9)/L. Cumulative incidence of discontinuation of systemic immune suppression at 1, 3, and 5 years after diagnosis of cGVHD were 22% (20%-25%), 34% (31%-37%), and 37% (34%-40%), respectively. This is the largest study elucidating variables affecting outcome after diagnosis of cGVHD in pediatric allograft recipients. These variables may be useful for risk stratification, development of future clinical trials, and family counseling in children with cGVHD.
authors: Division of Blood and Marrow Transplantation Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC 20010, USA. dajacobs@cnmc.org
authors: David A
authors: DA
authors: Jacobsohn
authors: Mukta
authors: M
authors: Arora
authors: John P
authors: JP
authors: Klein
authors: Anna
authors: A
authors: Hassebroek
authors: Mary E
authors: ME
authors: Flowers
authors: Corey S
authors: CS
authors: Cutler
authors: Alvaro
authors: A
authors: Urbano-Ispizua
authors: Brian J
authors: BJ
authors: Bolwell
authors: Joseph H
authors: JH
authors: Antin
authors: Michael
authors: M
authors: Boyiadzis
authors: Jean-Yves
authors: JY
authors: Cahn
authors: Mitchell S
authors: MS
authors: Cairo
authors: Roger H
authors: RH
authors: Herzig
authors: Luis M
authors: LM
authors: Isola
authors: Thomas R
authors: TR
authors: Klumpp
authors: Stephanie J
authors: SJ
authors: Lee
authors: Effie W
authors: EW
authors: Petersdorf
authors: Stella
authors: S
authors: Santarone
authors: Robert P
authors: RP
authors: Gale
authors: Harry C
authors: HC
authors: Schouten
authors: Stephen R
authors: SR
authors: Spellman
authors: Daniel J
authors: DJ
authors: Weisdorf
authors: John R
authors: JR
authors: Wingard
authors: Mary M
authors: MM
authors: Horowitz
authors: Steven Z
authors: SZ
authors: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005312:Fetal Blood / Q000637:transplantation*; D006086:Graft vs Host Disease / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000601:surgery*; D008297:Male; D009190:Myelodysplastic Syndromes / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult