Risk factors for acute GVHD and survival after hematopoietic cell transplantation.
Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for International Blood and Marrow Transplant Research, Minneapolis, MN. To understand the impact of transplant regimen on AGVHD risk, 6 treatment categories were evaluated: (1) myeloablative conditioning (MA) with total body irradiation (TBI) + PBSCs, (2) MA + TBI + BM, (3) MA + nonTBI + PBSCs, (4) MA + nonTBI + BM, (5) reduced intensity conditioning (RIC) + PBSCs, and (6) RIC + BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval [CI], 37%-41%) in the SD cohort and 59% (95% CI, 57%-61%) in the URD cohort. Patients receiving SD transplants with MA + nonTBI + BM and RIC + PBSCs had significantly lower risks of grades B-D AGVHD than patients in other treatment categories. Those receiving URD transplants with MA + TBI + BM, MA + nonTBI + BM, RIC + BM, or RIC + PBSCs had lower risks of grades B-D AGVHD than those in other treatment categories. The 5-year probabilities of survival were 46% (95% CI, 44%-49%) with SD transplants and 33% (95% CI, 31%-35%) with URD transplants. Conditioning intensity, TBI and graft source have a combined effect on risk of AGVHD that must be considered in deciding on a treatment strategy for individual patients.
Vanderbilt University Medical Center, Nashville, TN 37232-5505, USA. adan.jagasia@vanderbilt.edu
Madan
M
Jagasia
Mukta
M
Arora
Mary E D
ME
Flowers
Nelson J
NJ
Chao
Philip L
PL
McCarthy
Corey S
CS
Cutler
Alvaro
A
Urbano-Ispizua
Steven Z
SZ
Pavletic
Michael D
MD
Haagenson
Mei-Jie
MJ
Zhang
Joseph H
JH
Antin
Brian J
BJ
Bolwell
Christopher
C
Bredeson
Jean-Yves
JY
Cahn
Mitchell
M
Cairo
Robert Peter
RP
Gale
Vikas
V
Gupta
Stephanie J
SJ
Lee
Mark
M
Litzow
Daniel J
DJ
Weisdorf
Mary M
MM
Horowitz
Theresa
T
Hahn
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006648:Histocompatibility; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D015996:Survival Rate; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D014916:Whole-Body Irradiation; D055815:Young Adult