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Prepublished online as a Blood First Edition Paper on April 17, 2002; DOI 10.1182/blood-2001-11-0057.
Submitted November 27, 2001
Accepted March 13, 2002
Risk Factors for Acute Graft-Versus-Host Disease in Patients Transplanted with CD34+ Selected Blood Cells from HLA-Identical Siblings
Alvaro Urbano-Ispizua*, Ciril Rozman, Pedro Pimentel, Carlos Solano, Javier de la Rubia, Salut Brunet, Jaime Perez-Oteyza, Christelle Ferra, Javier Zuazu, Dolores Caballero, Joan Bargay, Alzira Carvalhais, Jose Luis Diez, Ildefonso Espigado, Adrian Alegre, Montserrat Rovira, Fernando Campilho, Jesus Odriozola, Miguel Angel Sanz, and Jordi Sierra
Institute of Hematology and Oncology, Hospital Clinic, Barcelona, Spain
Centro do Porto, Instituto Portugues de Oncologia, Oporto, Portugal
Hospital Clinico, Valencia, Spain
Hospital La Fe, Valencia, Spain
Hospital Sant Pau, Barcelona, Spain
Hospital Ramon y Cajal, Madrid, Spain
Hospital Duran i Reynals, Barcelona, Spain
Hospital Vall d'Hebron, Barcelona, Spain
Hospital Clinico, Salamanca, Spain
Hospital Son Dureta, Mallorca, Spain
Hospital Gregorio Maranon, Madrid, Spain
Hospital Virgen del Rocio, Sevilla, Spain
Hospital La Princesa, Madrid, Spain
* Corresponding author; email: aurbano{at}clinic.ub.es.
A study on 315 patients transplanted with CD34+ selected blood cells from HLA-identical siblings was performed, to determine risk factors for acute GVHD (aGVHD). Recipients of a dose of CD34+ cells (x106/kg) of <2, >2-4, and >4 had a cumulative incidence of aGVHD I-IV of 21%, 35%, and 43%, respectively (log-rank p=0.01); similarly, recipients of a dose of CD3+ cells (x106/kg) of <0.05, >0.05-0.1, and >0.1 had a cumulative incidence of aGVHD I-IV of 18%, 35%, and 44%, respectively (log-rank p=0.007). Using a Cox regression model, four independent factors for aGVHD I-IV were identified: increased CD34+ cell dose (p=0.02), increased CD3+ cell dose (p=0.02), female patients (p=0.01), and higher patient age (>42 years) (p=0.007). This study shows, for the first time in T-cell depleted transplants, a positive correlation between the number of CD34+ cells and aGVHD, and that the number of CD3+ cells necessary to initiate aGVHD is lower than previously reported.
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