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Value of day 100 screening studies for predicting the development of
chronic graft-versus-host disease after allogeneic bone marrow
transplantation
TP Loughran , K Sullivan, T Morton, C Beckham, M Schubert, R Witherspoon, G Sale, J Sanders, L Fisher and H Shulman
Clinical Research Division, Fred Hutchinson Cancer Research Center,
Seattle, WA 98104.
We prospectively evaluated 169 patients with a number of screening studies
performed between 71 to 121 days after allogeneic marrow transplantation to
detect the development of chronic graft-versus-host disease (GVHD). Group 1
patients (n = 78) were asymptomatic and had normal physical examinations at
the time of screening and, with a minimum of 8 years follow-up, have not
developed chronic GVHD. Group 2 patients (n = 38) had signs and symptoms of
chronic GVHD at time of testing. Group 3 patients (n = 53) were similar to
those in group 1 in having no clinically evident GVHD at the time of
testing, but later developed clinical chronic GVHD. Using time to an event
analysis, we compared patients in groups 1 and 3 to determine which of 17
clinical and laboratory factors evaluated at screening accurately predicted
the development of subsequent chronic GVHD. Multivariate analyses showed
several factors to have independent predictive value. In the first model,
results of oral biopsies were excluded since these were done only in one
half of the patients. Predictive factors in this analysis included: (1)
histologic findings of GVHD on skin biopsy, relative risk 3.23 (95%
confidence interval 1.75 to 5.94), P = .0002; and (2) history of grade II
through IV acute GVHD, relative risk 3.12 (95% confidence interval 1.72 to
5.64), P = .0002. When oral biopsy results were included in the second
model, independent risk factors included: (1) histologic findings of GVHD
on skin biopsy, relative risk 5.96 (95% confidence interval 1.95 to 18.19),
P = .0017; and (2) low numbers of immunoglobulin A (IgA)-bearing plasma
cells detected by direct immunofluorescence in salivary gland areas on oral
biopsy, relative risk 11.53 (95% confidence interval 2.51 to 52.03), P =
.0017. Our study demonstrates the value of day 100 screening studies for
predicting subsequent development of clinical chronic GVHD.
Volume 76,
Issue 1,
pp. 228-234,
07/01/1990
Copyright © 1990 by The American Society of Hematology
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