Risk Factors for Acute GVHD and Survival After Hematopoietic Cell Transplantation

Overview

Journal Blood

Publisher Elsevier

Specialty Hematology

Date 2011 Oct 20

PMID 22010102

Citations 295

Authors

Madan Jagasia

Mukta Arora

Mary E D Flowers

Nelson J Chao

Philip L McCarthy

Corey S Cutler

Alvaro Urbano-Ispizua

Steven Z Pavletic

Michael D Haagenson

Mei-Jie Zhang

Joseph H Antin

Brian J Bolwell

Christopher Bredeson

Jean-Yves Cahn

Mitchell Cairo

Robert Peter Gale

Vikas Gupta

Stephanie J Lee

Mark Litzow

Daniel J Weisdorf

Mary M Horowitz

Theresa Hahn

Affiliations

Soon will be listed here.

Abstract

Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for International Blood and Marrow Transplant Research, Minneapolis, MN. To understand the impact of transplant regimen on AGVHD risk, 6 treatment categories were evaluated: (1) myeloablative conditioning (MA) with total body irradiation (TBI) + PBSCs, (2) MA + TBI + BM, (3) MA + nonTBI + PBSCs, (4) MA + nonTBI + BM, (5) reduced intensity conditioning (RIC) + PBSCs, and (6) RIC + BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval [CI], 37%-41%) in the SD cohort and 59% (95% CI, 57%-61%) in the URD cohort. Patients receiving SD transplants with MA + nonTBI + BM and RIC + PBSCs had significantly lower risks of grades B-D AGVHD than patients in other treatment categories. Those receiving URD transplants with MA + TBI + BM, MA + nonTBI + BM, RIC + BM, or RIC + PBSCs had lower risks of grades B-D AGVHD than those in other treatment categories. The 5-year probabilities of survival were 46% (95% CI, 44%-49%) with SD transplants and 33% (95% CI, 31%-35%) with URD transplants. Conditioning intensity, TBI and graft source have a combined effect on risk of AGVHD that must be considered in deciding on a treatment strategy for individual patients.

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