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Blood, Vol. 94 No. 4 (August 15), 1999:
pp. 1465-1470
Risk Factors for Acute Graft-Versus-Host Disease After Allogeneic Blood
Stem Cell Transplantation
Donna Przepiorka,
Terry L. Smith,
Jody Folloder,
Issa Khouri,
Naoto T. Ueno,
Rakesh Mehra,
Martin Körbling,
Yang O. Huh,
Sergio Giralt,
James Gajewski,
Michele Donato,
Karen Cleary,
David Claxton,
Ira Braunschweig,
Koen van Besien,
Borje S. Andersson,
Paolo Anderlini, and
Richard Champlin
From the Departments of Blood and Marrow Transplantation,
Biomathematics, Laboratory Medicine and Pathology, University of Texas
M.D. Anderson Cancer Center, Houston, TX
We evaluated demographic characteristics and graft composition as
risk factors for acute graft-versus-host disease (GVHD) in 160 adult
recipients of HLA-identical allogeneic blood stem cell transplants. The
patients received a median nucleated cell dose of 7.9 × 108/kg and median C34+ cell dose of 5.6 × 106/kg. GVHD prophylaxis consisted of cyclosporine (CSA)
and steroids, tacrolimus (FK506) and steroids, or FK506 and
methotrexate. Grades 2 to 4 GVHD occurred in 31% (95% CI, 23% to
39%), and grades 3 to 4 GVHD in 14% (95% CI, 8% to 20%). In
univariate analyses, GVHD prophylaxis with CSA and high
CD34+ cell doses were significant risk factors for grades
2 to 4 GVHD, but diagnosis, age, use of total body irradiation, donor
sex, female donor for male recipient, donor parity, donor
alloimmunization, viral serology, nucleated cell dose,
CD3+ cell dose, and CD56+ cell dose did not
alter the incidence of GVHD significantly. With a CD34+
cell dose less than 8 × 106 CD34+ cells/kg,
the risk of grades 2 to 4 GVHD was significantly higher for those who
received CSA (39%, 95% CI, 21% to 47%) in comparison with those on
FK506 (18%, 95% CI, 10% to 26%) (P = .03), but GVHD prophylaxis regimen had less impact with a higher CD34+
cell dose (overall grades 2 to 4 GVHD rate 52%, 95% CI, 37% to 67%). GVHD prophylaxis and CD34+ cell dose are
independent risk factors for acute GVHD after allogeneic blood stem
cell transplantation.
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