title: Incidence, risk factors, and outcomes of sclerosis in patients with chronic graft-versus-host disease.
abstract: Sclerotic chronic graft-versus-host disease (GVHD) can result in disability after allogeneic hematopoietic cell transplantation. We assessed the incidence and risk factors of sclerosis and its association with transplant outcomes among 977 consecutive patients treated with systemic immunosuppression for chronic GVHD. Sclerosis was defined when cutaneous sclerosis, fasciitis, or joint contracture was first documented in the medical record. Seventy (7%) patients presented with sclerosis at the time of initial systemic treatment for chronic GVHD, and the cumulative incidence of sclerosis increased to 20% at 3 years. Factors associated with an increased risk of sclerosis included the use of a mobilized blood cell graft and a conditioning regimen with > 450 cGy total body irradiation. Factors associated with a decreased risk of sclerosis included the use of an HLA-mismatched donor and a major ABO-mismatched donor. Development of sclerosis was associated with longer time to withdrawal of immunosuppressive treatment but not with risks of overall mortality, nonrelapse mortality, or recurrent malignancy. We found a substantial incidence of sclerosis in patients with chronic GVHD. Development of sclerosis can cause disability but does not affect mortality or recurrent malignancy in patients with chronic GVHD.
authors.affiliation: Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.forename: Barry E
authors.initials: BE
authors.lastname: Storer
authors.forename: Effie W
authors.initials: EW
authors.lastname: Petersdorf
authors.forename: J Lee
authors.initials: JL
authors.lastname: Nelson
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Paul A
authors.initials: PA
authors.lastname: Carpenter
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: John A
authors.initials: JA
authors.lastname: Hansen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000473:pathology*; D006680:HLA Antigens; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012598:Sclerosis / Q000453:epidemiology; D019172:Transplantation Conditioning / Q000009:adverse effects; D055815:Young Adult
chemical_list: D006680:HLA Antigens
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