title: Older recipient age is paradoxically associated with a lower incidence of chronic GVHD in thymoglobulin recipients: a retrospective study exploring risk factors for GVHD in allogeneic transplantation with thymoglobulin GVHD prophylaxis.
abstract: Thymoglobulin (TG) given with conditioning for allogeneic haematopoietic SCT (alloHSCT) is effective in reducing the risk of acute and chronic GVHD (cGVHD). Whether conventional risk factors for GVHD apply to TG-conditioned alloHSCT is unknown. We retrospectively studied 356 adults from three centres who received TG 4.5 mg/kg prior to alloHSCT for haematologic malignancy. Donors were unrelated in 64%. At 3 years, OS was 61% (95% confidence interval (CI) 55-67%), cumulative incidence of relapse was 28% (95% CI 23-33%) and non-relapse mortality was 19% (14-24%). The cumulative incidences of grade 2-4, and grade 3-4 acute GVHD were 23% (95% CI 19-28%) and 10% (95% CI 6-13%), respectively. The cumulative incidence of cGVHD requiring systemic immunosuppression (cGVHD-IS) at 3 years was 32% (95% CI 27-37%). On multivariate analysis, counterintuitively, recipient age over 40 was associated with a significantly decreased risk of cGVHD-IS (P=0.001). We report for the first time a paradoxical association of older age with reduced cGVHD in TG recipients, and conclude that traditional risk factors for GVHD may behave differently in the context of pre-transplant TG.
authors: 1] Department of Clinical Haematology & Bone Marrow Transplant Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia [2] Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors: A B M
authors: AB
authors: Lim
authors: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors: J
authors: J
authors: Storek
authors: Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors: A
authors: A
authors: Beligaswatte
authors: Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors: M
authors: M
authors: Collins
authors: Melbourne EpiCentre, Parkville, Victoria, Australia.
authors: M
authors: M
authors: Tacey
authors: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors: T
authors: T
authors: Williamson
authors: Department of Clinical Haematology & Bone Marrow Transplant Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors: K
authors: K
authors: Mason
authors: Department of Clinical Haematology & Bone Marrow Transplant Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors: E
authors: E
authors: Li
authors: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors: M A
authors: MA
authors: Chaudhry
authors: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors: J A
authors: JA
authors: Russell
authors: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors: A
authors: A
authors: Daly
authors: 1] Department of Clinical Haematology & Bone Marrow Transplant Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia [2] Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors: J
authors: J
authors: Szer
authors: Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors: I
authors: I
authors: Lewis
authors: 1] Department of Clinical Haematology & Bone Marrow Transplant Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia [2] Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
authors: D
authors: D
authors: Ritchie
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D064591:Allografts; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality* / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D000961:Antilymphocyte Serum; C512542:thymoglobulin
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