title: Risk Factors for Steroid-Refractory Acute Graft-versus-Host Disease after Allogeneic Stem Cell Transplantation from Matched Related or Unrelated Donors.
abstract: We performed a retrospective study to identify pretransplantation risk factors for steroid-refractory (SR) acute graft-versus host disease (aGVHD) after allogeneic stem cell transplantation from matched donors in 630 adult patients who underwent transplantation at our center between 2000 and 2012. The cumulative incidence (CI) of SR aGVHD was 11.3% ± 2.3%. The identified independent risk factors were matched unrelated donor (hazard ratio [HR], 2.52; P = .001), female donor for male recipient (HR, 1.84; P = .023) and absence of antithymocyte globulin (HR, 2.02; P = .005). Three risk groups were defined according to the presence of these risk factors. In the whole cohort, the CI of SR aGVHD was 3.5% ± 1.7% in the low-risk group (0 risk factor, n = 115), 9.3% ± 1.6% in the intermediate-risk group (1 risk factor, n = 323), and 19.3% ± 2.9% in the high-risk group (2 or 3 risk factors, n = 192). Our study suggests that pretransplantation characteristics might help identify patients at high risk for SR aGVHD. A risk adapted first-line treatment of aGVHD could be evaluated in those patients.
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Calmettes
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France. Electronic address: stephane.vigouroux@chu-bordeaux.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Vigouroux
authors.affiliation: Université Pierre et Marie Curie, INSERM U 938, Service d'Hématologie et de Thérapie Cellulaire, CHU Saint-Antoine, Paris, France.
authors.forename: Myriam
authors.initials: M
authors.lastname: Labopin
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Reza
authors.initials: R
authors.lastname: Tabrizi
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Dupuytren, Limoges, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Turlure
authors.affiliation: Laboratoire HLA, Etablissement Français du Sang, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Lafarge
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Gérald
authors.initials: G
authors.lastname: Marit
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Pigneux
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Leguay
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Krimo
authors.initials: K
authors.lastname: Bouabdallah
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Marie-Sarah
authors.initials: MS
authors.lastname: Dilhuydy
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Cédric
authors.initials: C
authors.lastname: Duclos
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mohr
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Axelle
authors.initials: A
authors.lastname: Lascaux
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Dumas
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Dimicoli-Salazar
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Saint-Lézer
authors.affiliation: Service d'Hématologie et de Thérapie Cellulaire, CHU Haut-Lévêque, Bordeaux, France; Université Bordeaux Segalen, Bordeaux, France.
authors.forename: Noël
authors.initials: N
authors.lastname: Milpied
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality* / Q000628:therapy; D019337:Hematologic Neoplasms / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation; D061349:Unrelated Donors
keywords: Risk factors; Steroid-refractory acute graft-versus-host disease