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Blood, 1 December 2004, Vol. 104, No. 12, pp. 3501-3506.
Prepublished online as a Blood First Edition Paper on August 3, 2004; DOI 10.1182/blood-2004-01-0200.
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CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Duration of immunosuppressive treatment for chronic graft-versus-host disease
Betty L. Stewart,
Barry Storer,
Jan Storek,
H. Joachim Deeg,
Rainer Storb,
John A. Hansen,
Frederick R. Appelbaum,
Paul A. Carpenter,
Jean E. Sanders,
Hans-Peter Kiem,
Richard A. Nash,
Effie W. Petersdorf,
Carina Moravec,
A. James Morton,
Claudio Anasetti,
Mary E. D. Flowers, and
Paul J. Martin
From the Division of Clinical Research, Fred Hutchinson Cancer Research Center and the Departments of Medicine and Pediatrics, University of Washington, Seattle, WA; and Wesley Haematology and Oncology Clinics of Australasia, Auchenflower, Australia.
Chronic graft-versus-host disease (GVHD) requires long-term immunosuppressive therapy after hematopoietic cell transplantation. We retrospectively analyzed a cohort of 751 patients with chronic GVHD to identify characteristics associated with the duration of immunosuppressive treatment. Among the 274 patients who discontinued immunosuppressive therapy after resolution of chronic GVHD before recurrent malignancy or death, the median duration of treatment was 23 months. Results of a multivariable model showed that treatment was prolonged in patients who received peripheral blood cells, in male patients with female donors, in those with graft-versus-host HLA mismatching, and in those with hyperbilirubinemia or multiple sites affected by chronic GHVD at the onset of the disease. Nonrelapse mortality was increased among patients with HLA mismatching or hyperbilirubinemia but not among those with other risk factors associated with prolonged treatment for chronic GVHD. Nonrelapse mortality was also increased in older patients and those with older donors, in patients with platelet counts less than 100 000/µL or progressive onset of chronic GVHD from acute GVHD, and in those receiving higher doses of prednisone immediately before the diagnosis of chronic GVHD. After the dose of prednisone was taken into account, progressive onset was not associated with an increased risk of nonrelapse mortality.
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