title: GvHD after umbilical cord blood transplantation for acute leukemia: an analysis of risk factors and effect on outcomes.
abstract: Using the Center for International Blood and Marrow Transplant Research (CIBMTR) registry, we analyzed 1404 umbilical cord blood transplantation (UCBT) patients (single (<18 years)=810, double (⩾18 years)=594) with acute leukemia to define the incidence of acute GvHD (aGvHD) and chronic GvHD (cGvHD), analyze clinical risk factors and investigate outcomes. After single UCBT, 100-day incidence of grade II-IV aGvHD was 39% (95% confidence interval (CI), 36-43%), grade III-IV aGvHD was 18% (95% CI, 15-20%) and 1-year cGvHD was 27% (95% CI, 24-30%). After double UCBT, 100-day incidence of grade II-IV aGvHD was 45% (95% CI, 41-49%), grade III-IV aGvHD was 22% (95% CI, 19-26%) and 1-year cGvHD was 26% (95% CI, 22-29%). For single UCBT, multivariate analysis showed that absence of antithymocyte globulin (ATG) was associated with aGvHD, whereas prior aGvHD was associated with cGvHD. For double UCBT, absence of ATG and myeloablative conditioning were associated with aGvHD, whereas prior aGvHD predicted for cGvHD. Grade III-IV aGvHD led to worse survival, whereas cGvHD had no significant effect on disease-free or overall survival. GvHD is prevalent after UCBT with severe aGvHD leading to higher mortality. Future research in UCBT should prioritize prevention of GvHD.
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Y-B
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: T
authors.initials: T
authors.lastname: Wang
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M T
authors.initials: MT
authors.lastname: Hemmer
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Brady
authors.affiliation: Utah Blood and Marrow Transplant Program, Adults, Salt Lake City, UT, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Couriel
authors.affiliation: Division of Cancer Medicine, Department of Stem Cell Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Alousi
authors.affiliation: H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Pidala
authors.affiliation: Department of Hematology, Hospital Clinic, University of Barcelona, IDIBAPS and Institute of Research Josep Carreras, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Urbano-Ispizua
authors.affiliation: The University of Michigan, Ann Arbor, MI, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Choi
authors.affiliation: Department of Blood and Marrow Transplantation, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: T
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Kyushu University Hospital, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Teshima
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: Division of Bone Marrow Transplant, Seattle Cancer Care Alliance, Seattle, WA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Wirk
authors.affiliation: Adult Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
authors.forename: H
authors.initials: H
authors.lastname: Abdel-Azim
authors.affiliation: Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Lehmann
authors.affiliation: Division of Hematology/Oncology and HSCT, The Center for Cancer and Blood Disorders, Children's Hospital/Louisiana State University Medical Center, New Orleans, LA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Pediatric Hematology/Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: M
authors.initials: M
authors.lastname: Bitan
authors.affiliation: Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Department of Pediatrics, New York Medical College, Valhalla, NY, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Cairo
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Qayed
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Salit
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, UK.
authors.forename: R P
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.affiliation: Division of Hematology, The Ohio State University Medical Center, Columbus, OH, USA.
authors.forename: S
authors.initials: S
authors.lastname: Jaglowski
authors.affiliation: Royal Melbourne Hospital City Campus, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Bajel
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: B
authors.initials: B
authors.lastname: Savani
authors.affiliation: Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors.forename: H
authors.initials: H
authors.lastname: Frangoul
authors.affiliation: Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
authors.forename: I D
authors.initials: ID
authors.lastname: Lewis
authors.affiliation: Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Storek
authors.affiliation: Baylor University Medical Center, Dallas, TX, USA.
authors.forename: M
authors.initials: M
authors.lastname: Askar
authors.affiliation: Department of Blood and Marrow Transplantation, H Lee Mofitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Ringden
authors.affiliation: Blood and Marrow Transplantation Program and Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY, USA.
authors.forename: R
authors.initials: R
authors.lastname: Reshef
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.|Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden.
authors.forename: R F
authors.initials: RF
authors.lastname: Olsson
authors.affiliation: Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: S
authors.initials: S
authors.lastname: Hashmi
authors.affiliation: National Cancer Research Center, East Hospital, Kashiwa, Chiba, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Seo
authors.affiliation: Massachusetts General Hospital, Boston, MA, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: Spitzer
authors.affiliation: University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: MacMillan
authors.affiliation: University of Minnesota Medical Center, Fairview, Minneapolis, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Lazaryan
authors.affiliation: Center for International Blood and Marrow Transplant Research, National Marrow Donor Program/Be The Match, Minneapolis, MN, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Spellman
authors.affiliation: Division of Hematology, Oncology, Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: M
authors.initials: M
authors.lastname: Arora
authors.affiliation: Center for Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: C S
authors.initials: CS
authors.lastname: Cutler
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007938:Leukemia / Q000401:mortality* / Q000628:therapy*; D008297:Male; D012042:Registries; D015996:Survival Rate; D019172:Transplantation Conditioning
chemical_list: D000961:Antilymphocyte Serum