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Prepublished online as a Blood First Edition Paper on March 27, 2003; DOI 10.1182/blood-2002-08-2628. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-08-2628v1 102/2/756    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Mielcarek, M. Articles by Storb, R. Search for Related Content PubMed PubMed Citation Articles by Mielcarek, M. Articles by Storb, R. Related Collections Transplantation Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 July 2003, Vol. 102, No. 2, pp. 756-762 TRANSPLANTATION Graft-versus-host disease after nonmyeloablative versus conventional hematopoietic stem cell transplantation Marco Mielcarek, Paul J. Martin, Wendy Leisenring, Mary E. D. Flowers, David G. Maloney, Brenda M. Sandmaier, Michael B. Maris, and Rainer Storb From the Divisions of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center; and the Departments of Medicine and Biostatistics, University of Washington School of Medicine, Seattle It is unknown whether the severity, timing, and quality of graft-versus-host disease (GVHD) may be different after nonmyeloablative as compared with myeloablative hematopoietic stem cell transplantation (HSCT). Therefore, GVHD incidence, morbidity of skin, liver, and gut, requirements for immunosuppressive therapy, and survival were retrospectively analyzed in 44 patients who underwent nonablative HSCT and 52 who underwent ablative HSCT (median ages, 56 and 54 years, respectively). The nonablative transplantation regimen consisted of low-dose total body irradiation (TBI), preceded in some patients by fludarabine administration and followed in all patients by immunosuppression with mycophenolate mofetil (MMF) and cyclosporine (CSP). Those who underwent myeloablative HSCT were prepared with different TBI- and non-TBI–containing regimens and received CSP plus methotrexate or MMF for GVHD prophylaxis. The cumulative incidence of grades II-IV acute GVHD was lower after nonablative transplantation (64% vs 85%; P = .001), but there were no differences in the cumulative incidence of chronic GVHD requiring treatment (73% vs 71%; P = .96). Nonablative transplantation was associated with the delayed initiation of steroid treatment for GVHD (0.95 months vs 3.0 months; P < .001) and with the use of fewer systemic immunosuppressants in the first 3 months after transplantation (P ≤ .04). This corresponded to more prevalent skin and more severe gut morbidity 6 to 12 months after nonablative transplantation. Our results show that nonablative HSCT is associated with a syndrome of acute GVHD occurring after day 100 in many patients. This "late-onset acute GVHD" should be taken into consideration in the design of prospective studies comparing GVHD resulting from the two types of transplantation procedures. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: G. Socie and B. R. Blazar Acute graft-versus-host disease: from the bench to the bedside Blood, November 12, 2009; 114(20): 4327 - 4336. [Abstract] [Full Text] [PDF] H. E. Kohrt, B. B. Turnbull, K. 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