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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1695-1700
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Chronic graft-versus-host disease after allogeneic blood stem
cell transplantation
Donna Przepiorka,
Paolo Anderlini,
Rima Saliba,
Karen Cleary,
Rakesh Mehra,
Issa Khouri,
Yang O. Huh,
Sergio Giralt,
Ira Braunschweig,
Koen van
Besien, and
Richard Champlin
From the Baylor College of Medicine Center for Cell and
Gene Therapy, and the Departments of Blood and Marrow Transplantation,
Pathology, and Laboratory Medicine, University of Texas M. D. Anderson
Cancer Center, Houston, TX.
The incidence, characteristics, risk factors for, and impact
of chronic graft-vs-host disease (GVHD) were evaluated in a
consecutive series of 116 evaluable HLA-identical blood stem cell
transplant recipients. Minimum follow-up was 18 months. Limited chronic
GVHD occurred in 6% (95% confidence interval [CI], 0%-13%), and
clinical extensive chronic GVHD in 71% (95% CI, 61%-80%). The
cumulative incidence was 57% (95% CI, 48%-66%). In univariate
analyses, GVHD prophylaxis other than tacrolimus and methotrexate,
prior grades 2 to 4 acute GVHD, use of corticosteroids on day 100, and
total nucleated cell dose were significant risk factors for clinical extensive chronic GVHD. On multivariate analysis, GVHD prophylaxis with
tacrolimus and methotrexate was associated with a reduced risk of
chronic GVHD (hazard ratio [HR], 0.35; P = .001),
whereas the risk was increased with prior acute GVHD (HR, 1.67;
P = .046). When adjusted for disease status at the time
of transplantation, high-risk chronic GVHD had an adverse impact on
overall mortality (HR, 6.6; P < .001) and treatment
failure (HR, 5.2; P < .001) at 18 months. It was
concluded that there is a substantial rate of chronic GVHD after
HLA-identical allogeneic blood stem cell transplantation, that clinical
factors may alter the risk of chronic GVHD, and that high-risk chronic
GVHD adversely affects outcome.
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