Risk factors for acute GVHD and survival after hematopoietic cell transplantation.

Publication Type:

Journal Article

Source:

Blood, Volume 119, Issue 1, p.296-307 (2012)

Keywords:

*Whole-Body Irradiation, 2012, Acute Disease, Acute Disease Adolescent Adult Aged Child, Adolescent, Adult, Aged, Center-Authored Paper, Child, Child, Preschool, Clinical Research Division, Female, Graft vs Host Disease, Hematologic Neoplasms, hematopoietic stem cell transplantation, Histocompatibility, Humans, Infant, Male, Middle Aged, November 2011, Retrospective Studies, Risk Factors, Siblings, Survival Rate, Tissue Donors, Transplantation Conditioning, Transplantation, Homologous, Unrelated Donors, Young Adult

Abstract:

Risk factors for acute graft-versus-host disease (AGVHD), overall survival and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SD) (n=3191) or unrelated donors (URD) (n=2370) and reported to the CIBMTR. To understand the impact of transplant regimen on AGVHD risk, six treatment categories were evaluated: 1.) myeloablative conditioning (MA) with total body irradiation (TBI)+ peripheral blood stem cells (PBSC); 2.) MA+TBI+bone marrow (BM); 3.) MA+nonTBI+PBSC; 4.) MA+nonTBI+BM; 5.) reduced-intensity conditioning (RIC)+PBSC; 6.) RIC+BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval: 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+PBSC 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+PBSC 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.