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Chronic graft-versus-host disease in 52 patients: adverse natural course
and successful treatment with combination immunosuppression
KM Sullivan, HM Shulman, R Storb, PL Weiden, RP Witherspoon, GB McDonald, MM Schubert, K Atkinson and ED Thomas
Fifty-two of 175 (30%) survivors of allogeneic marrow transplantation
developed chronic graft-versus-hose diseases (GVHD). Five with limited
chronic GVHD had an indolent clinical course with involvement of only the
skin and liver. Forty-seven with extensive chronic GVHD had an unfavorable
multiorgan disorder that resembled several autoimmune diseases. Thirteen
patients with extensive disease (group I) were not treated and only 2
survive with Karnofsky scores >- 70%. Mortality resulted from infections
and morbidity from sica syndrome, pulmonary and hepatic insufficiency,
scleroderma-like skin disease, and contractures. Another 13 (group II)
received a median of 8 mo prednisone and/or a brief course of antithymocyte
globulin, and 3 survive without disability. The other 21 (group III) were
treated with a combination of prednisone (1.0 mg/kg/q.o.d.) and either
cyclophosphamide, procarbazine, or azathioprine (all 1.5 mg/kg/day) for a
median of 13 mo. Combination therapy was well tolerated with only modest
myelotoxicity. Fifteen in group III had a good and 4 a fair response to
treatment while 2 with no response died. Azathioprine and prednisone was
the most effective regimen. All therapy has been discontinued in 12 group
III patients: GVHD returned in 5 (including 2 who died in spite of
retreatment) while 7 remain free of GVHD for a median of 11 (range 6-30) mo
observation. Only I group III survivor is disabled and 16 of the original
21 are alive 2-4 yr after transplant with Karnofsky scores of 70%-100%.
Thus, combination immmunosuppression appears to favorably affect and, in
some cases, premanently arrest the adverse natural course of extensive
chronic GVHD.
Volume 57,
Issue 2,
pp. 267-276,
02/01/1981
Copyright © 1981 by The American Society of Hematology

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S. Aractingi and O. Chosidow
Cutaneous Graft-versus-Host Disease
Arch Dermatol,
May 1, 1998;
134(5):
602 - 612.
[Abstract]
[Full Text]
[PDF]
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E. Rodriguez-Inigo, J.-F. Tomas, V. Gomez-Garcia de Soria, J. Bartolome, I. Pinilla, M.-J. Amaro, V. Carreno, and J.-M. Fernandez-Ranada
Hepatitis C and G Virus Infection and Liver Dysfunction After Allogeneic Bone Marrow Transplantation: Results From a Prospective Study
Blood,
August 1, 1997;
90(3):
1326 - 1331.
[Abstract]
[Full Text]
[PDF]
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H. J. Deeg, D. Lin, W. Leisenring, M. Boeckh, C. Anasetti, F. R. Appelbaum, T. R. Chauncey, K. Doney, M. Flowers, P. Martin, et al.
Cyclosporine or Cyclosporine Plus Methylprednisolone for Prophylaxis of Graft-Versus-Host Disease: A Prospective, Randomized Trial
Blood,
May 15, 1997;
89(10):
3880 - 3887.
[Abstract]
[Full Text]
[PDF]
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S.-B. Woo, S. J. Lee, and M. M. Schubert
Graft-vs.-Host Disease
Critical Reviews in Oral Biology & Medicine,
January 1, 1997;
8(2):
201 - 216.
[Abstract]
[Full Text]
[PDF]
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E. Behar, N. J. Chao, D. D. Hiraki, S. Krishnaswamy, B. W. Brown, J. L. Zehnder, and F. C. Grumet
Polymorphism of Adhesion Molecule CD31 and Its Role in Acute Graft-Versus-Host Disease
N. Engl. J. Med.,
February 1, 1996;
334(5):
286 - 291.
[Abstract]
[Full Text]
[PDF]
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N. M. Coskuncan, D. A. Jabs, J. P. Dunn, J. A. Haller, W. R. Green, G. B. Vogelsang, and G. W. Santos
The Eye in Bone Marrow Transplantation: VI. Retinal Complications
Arch Ophthalmol,
March 1, 1994;
112(3):
372 - 379.
[Abstract]
[PDF]
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J. P. Dunn, D. A. Jabs, J. Wingard, C. Enger, G. Vogelsang, and G. Santos
Bone Marrow Transplantation and Cataract Development
Arch Ophthalmol,
October 1, 1993;
111(10):
1367 - 1373.
[Abstract]
[PDF]
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R. H. Fried, C. S. Murakami, L. D. Fisher, R. A. Willson, K. M. Sullivan, and G. B. McDonald
Ursodeoxycholic Acid Treatment of Refractory Chronic Graft-versus-Host Disease of the Liver
Ann Intern Med,
April 15, 1992;
116(8):
624 - 629.
[Abstract]
[PDF]
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R. M. Jampel, E. R. Farmer, G. B. Vogelsang, J. Wingard, G. W. Santos, and W. L. Morison
PUVA Therapy for Chronic Cutaneous Graft-vs-Host Disease
Arch Dermatol,
November 1, 1991;
127(11):
1673 - 1678.
[Abstract]
[PDF]
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M. H. Sayegh, N. A. Fine, J. L. Smith, H. G. Rennke, E. L. Milford, and N. L. Tilney
Immunologic Tolerance to Renal Allografts after Bone Marrow Transplants from the Same Donors
Ann Intern Med,
June 1, 1991;
114(11):
954 - 955.
[Abstract]
[PDF]
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J. G. Clark, S. W. Crawford, D. K. Madtes, and K. M. Sullivan
Obstructive Lung Disease after Allogeneic Marrow Transplantation: Clinical Presentation and Course
Ann Intern Med,
September 1, 1989;
111(5):
368 - 376.
[Abstract]
[PDF]
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D. A. Jabs, J. Wingard, W. R. Green, E. R. Farmer, G. Vogelsang, and R. Saral
The Eye in Bone Marrow Transplantation: III. Conjunctival Graft-vs-Host Disease
Arch Ophthalmol,
September 1, 1989;
107(9):
1343 - 1348.
[Abstract]
[PDF]
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P. Kalhs, S. Panzer, K. Kletter, E. Minar, M. Stain-Kos, R. Walter, K. Lechner, and W. Hinterberger
Functional Asplenia after Bone Marrow Transplantation: A Late Complication Related to Extensive Chronic Graft-Versus-Host Disease
Ann Intern Med,
September 15, 1988;
109(6):
461 - 464.
[Abstract]
[PDF]
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N. R. Howe and P. G. Lang
Squamous Cell Carcinoma of the Sole in a Patient With Chronic Graft-vs-Host Disease
Arch Dermatol,
August 1, 1988;
124(8):
1244 - 1245.
[Abstract]
[PDF]
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J. G. CLARK, D. A. SCHWARTZ, N. FLOURNOY, K. M. SULLIVAN, S. W. CRAWFORD, and E. D. THOMAS
Risk Factors for Airflow Obstruction in Recipients of Bone Marrow Transplants
Ann Intern Med,
November 1, 1987;
107(5):
648 - 656.
[Abstract]
[PDF]
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C. ANASETTI, K. C. DONEY, R. STORB, J. D. MEYERS, V. T. FAREWELL, C. D. BUCKNER, F. R. APPELBAUM, K. M. SULLIVAN, R. A. CLIFT, H. J. DEEG, et al.
Marrow Transplantation for Severe Aplastic Anemia: Long-Term Outcome in Fifty "Untransfused" Patients
Ann Intern Med,
April 1, 1986;
104(4):
461 - 466.
[Abstract]
[PDF]
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A. P. Barrett and A. M. Bilous
Oral Patterns of Acute and Chronic Graft-v-Host Disease
Arch Dermatol,
November 1, 1984;
120(11):
1461 - 1465.
[Abstract]
[PDF]
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M. M. Schubert, K. M. Sullivan, T. H. Morton, K. T. Izutsu, D. E. Peterson, N. Flournoy, E. L. Truelove, G. E. Sale, C. D. Buckner, R. Storb, et al.
Oral Manifestations of Chronic Graft-v-Host Disease
Arch Intern Med,
August 1, 1984;
144(8):
1591 - 1595.
[Abstract]
[PDF]
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W. D. James and R. B. Odom
Graft-v-Host Disease
Arch Dermatol,
August 1, 1983;
119(8):
683 - 689.
[Abstract]
[PDF]
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M. K. Jack, G. M. Jack, G. E. Sale, H. M. Shulman, and K. M. Sullivan
Ocular Manifestations of Graft-v-Host Disease
Arch Ophthalmol,
July 1, 1983;
101(7):
1080 - 1084.
[Abstract]
[PDF]
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R. STORB, R. L. PRENTICE, K. M. SULLIVAN, H. M. SHULMAN, H. J. DEEG, K. C. DONEY, C. D. BUCKNER, R. A. CLIFT, R. P. WITHERSPOON, F. A. APPELBAUM, et al.
Predictive Factors in Chronic Graft-Versus-Host Disease in Patients with Aplastic Anemia Treated by Marrow Transplantation from HLA-Identical Siblings
Ann Intern Med,
April 1, 1983;
98(4):
461 - 466.
[Abstract]
[PDF]
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L. W. Hirst, D. A. Jabs, P. J. Tutschka, W. R. Green, and G. W. Santos
The Eye in Bone Marrow Transplantation: I. Clinical Study
Arch Ophthalmol,
April 1, 1983;
101(4):
580 - 584.
[Abstract]
[PDF]
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R. P. GALE, R. E. CHAMPLIN, S. A. FEIG, and J. H. FITCHEN
Aplastic Anemia: Biology and Treatment
Ann Intern Med,
October 1, 1981;
95(4):
477 - 494.
[Abstract]
[PDF]
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