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Blood, 1 April 2007, Vol. 109, No. 7, pp. 2751-2758. Prepublished online as a Blood First Edition Paper on November 30, 2006; DOI 10.1182/blood-2006-07-034348. This Article Full Text (PDF) All Versions of this Article: blood-2006-07-034348v1 109/7/2751    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Saliba, R. M Articles by Couriel, D. R Search for Related Content PubMed PubMed Citation Articles by Saliba, R. M Articles by Couriel, D. R Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted July 20, 2006 Accepted November 17, 2006 Hyper-acute GVHD: risk factors, outcomes, and clinical implications Rima M Saliba, Marcos de Lima, Sergio Giralt, Borje Andersson, Issa F Khouri, Chitra Hosing, Shubhra Ghosh, Joyce Neumann, Yvonne Hsu, Jorge De Jesus, Muzaffar H Qazilbash, Richard E Champlin, and Daniel R Couriel* Dept of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX * Corresponding author; email: dcouriel{at}mdanderson.org. Acute graft-versus-host disease (GVHD) is a major limiting factor in allogeneic hematopoietic stem cell transplantation (HSCT), and the timing of acute GVHD may affect patient outcomes. We evaluated the incidence, risk factors, clinical manifestations, and outcomes of hyper-acute GVHD, defined as that occurring within 14 days after transplant, among 809 consecutive HSCT at The University of Texas M. D. Anderson Cancer Center. Of 265 patients with grade II-IV acute GVHD, 27% had biopsy-proven hyper-acute GVHD. Skin involvement was significantly more common (88% versus 44%) and more severe (stage III-IV, 88% versus 66%) in the hyper-acute group compared with acute GVHD diagnosed after day 14. On multivariate analysis, significant risk factors for hyper-acute GVHD included a mismatched related or matched unrelated donor, a myeloablative conditioning regimen, more than 5 prior chemotherapy regimens, and donor-recipient sex mismatch. Hyper-acute GVHD was associated with a significantly lower response rate to first-line therapy and a higher rate of non-relapse mortality in patients with a mismatched related or matched unrelated donor graft. In conclusion, hyper-acute GVHD accounts for a substantial proportion of grade II-IV acute GVHD after HSCT. Patients at high risk or with a diagnosis of hyper-acute GVHD should be included in clinical studies. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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