title: Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research.
abstract: Although transplant practices have changed over the last decades, no information is available on trends in incidence and outcome of chronic graft-versus-host disease (cGVHD) over time. This study used the central database of the Center for International Blood and Marrow Transplant Research (CIBMTR) to describe time trends for cGVHD incidence, nonrelapse mortality, and risk factors for cGVHD. The 12-year period was divided into 3 intervals, 1995 to 1999, 2000 to 2003, and 2004 to 2007, and included 26,563 patients with acute leukemia, chronic myeloid leukemia, and myelodysplastic syndrome. Multivariate analysis showed an increased incidence of cGVHD in more recent years (odds ratio = 1.19, P < .0001), and this trend was still seen when adjusting for donor type, graft type, or conditioning intensity. In patients with cGVHD, nonrelapse mortality has decreased over time, but at 5 years there were no significant differences among different time periods. Risk factors for cGVHD were in line with previous studies. This is the first comprehensive characterization of the trends in cGVHD incidence and underscores the mounting need for addressing this major late complication of transplantation in future research.
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California.
authors.forename: Sally
authors.initials: S
authors.lastname: Arai
authors.affiliation: Division of Hematology, Oncology and Transplant, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, Minnesota.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Spellman
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wensheng
authors.initials: W
authors.lastname: He
authors.affiliation: Division of Hematology/Oncology, The University of Michigan, Ann Arbor, Michigan.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Couriel
authors.affiliation: Division of Hematology/Oncology, Hospital Clinic of Barcelona, Barcelona, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano-Ispizua
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.affiliation: Department of Hematology, IRCCS AOU San Martino-IST, Genoa, Italy.
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Bacigalupo
authors.affiliation: Branch of Hematology, National Heart Lung and Blood Institute, Bethesda, Maryland.
authors.forename: Minoo
authors.initials: M
authors.lastname: Battiwalla
authors.affiliation: Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Mark B
authors.initials: MB
authors.lastname: Juckett
authors.affiliation: Divison of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
authors.forename: Alison W
authors.initials: AW
authors.lastname: Loren
authors.affiliation: Divison of Bone Marrow Transplantation, Temple Bone Marrow Transplant Program, Philadelphia, Pennsylvania.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.affiliation: Divison of Bone Marrow Transplant, Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Prockup
authors.affiliation: Division of Clinical Immunology and Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Olle T H
authors.initials: OT
authors.lastname: Ringdén
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Division of Hematology, Hôpital Saint Louis, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.affiliation: Department of Pediatric Hematology/Oncology/BMT, British Columbia's Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Schultz
authors.affiliation: Department of Bone Marrow Transplant-Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Spitzer
authors.affiliation: Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Teshima
authors.affiliation: Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Bredeson
authors.affiliation: Division of Blood and Marrow Transplantation Center for Cancer and Blood Disorders, Children's National Health Systems, Washington, DC.
authors.forename: David A
authors.initials: DA
authors.lastname: Jacobsohn
authors.affiliation: Division of Pediatric Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hayashi
authors.affiliation: Department of Microbiology and Molecular Genetics, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: William R
authors.initials: WR
authors.lastname: Drobyski
authors.affiliation: Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Haydar A
authors.initials: HA
authors.lastname: Frangoul
authors.affiliation: Section of Hematology Oncology, Banner MD Anderson Cancer Center, Gilbert, Arizona.
authors.forename: Görgün
authors.initials: G
authors.lastname: Akpek
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.affiliation: Departments of Oncology, Paediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Lewis
authors.affiliation: Division of Experimental Medicine, Department of Medicine, Hematology Research Centre, Imperial College London, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: John
authors.initials: J
authors.lastname: Koreth
authors.affiliation: Division of Cell Therapy and Hematologica, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
authors.forename: Mahmoud D
authors.initials: MD
authors.lastname: Aljurf
authors.affiliation: Department of Medicine-Hematology and Oncology, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Cooper
authors.affiliation: Medical Director, Cleveland Cord Blood Center, Cleveland, Ohio.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Laughlin
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Hsu
authors.affiliation: Division of Hematology/Oncology/Bone Marrow Transplantation, Department of Medicine, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Peiman
authors.initials: P
authors.lastname: Hematti
authors.affiliation: Department of Internal Medicine, Isala Clinics, Zwolle, Netherlands.
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
authors.affiliation: Florida Center for Cellular Therapy, Florida Hospital, Orlando, Florida.
authors.forename: Melhelm M
authors.initials: MM
authors.lastname: Solh
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, Shands HealthCare & University of Florida, Gainesville, Florida.
authors.forename: Maxim
authors.initials: M
authors.lastname: Norkin
authors.affiliation: Division of Hematology/Oncology, University of Florida, Gainesville, Florida.
authors.forename: Vijay
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Department of Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.affiliation: Division of Cancer Epidemiology & Genetics, NIH-NCI Clinical Genetics Branch, Rockville, Maryland.
authors.forename: Shahinaz
authors.initials: S
authors.lastname: Gadalla
authors.affiliation: Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jenna D
authors.initials: JD
authors.lastname: Goldberg
authors.affiliation: Blood & Marrow Transplant Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Philip L
authors.initials: PL
authors.lastname: McCarthy
authors.affiliation: Department of Hematology, Instituto de Biomedicina de Sevilla, Seville, Spain.
authors.forename: José A
authors.initials: JA
authors.lastname: Pérez-Simón
authors.affiliation: Department of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Lewis
authors.affiliation: Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Nagoya University Graduate School of Medicine, Nagoya, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Atsuta
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Olsson
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.affiliation: Deparment of Hematology, Institut Paoli Calmettes, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Pidala
authors.affiliation: Divison of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Division of Pediatric Hematology, Oncology, and Stem Cell Transplantation, Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Prakash
authors.initials: P
authors.lastname: Satwani
authors.affiliation: Department of Internal Medicine, University Hospital Dresden, Dresden, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bornhäuser
authors.affiliation: Divison of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Division of Hematology, Oncology and Transplant, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mary M
authors.initials: MM
authors.lastname: Horowitz
authors.affiliation: NIH-NCI Experimental Transplantation and Immunology Branch, Bethesda, Maryland. Electronic address: pavletis@mail.nih.gov.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Pavletic
mesh_terms: D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D009190:Myelodysplastic Syndromes / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D016017:Odds Ratio; D016019:Survival Analysis; D014184:Transplantation, Homologous
chemical_list: D019653:Myeloablative Agonists
keywords: Allogeneic transplant; Incidence; Nonrelapse mortality; cGVHD