Related Experiment Videos
Chronic graft-versus-host disease after allogeneic blood stem cell transplantation
D Przepiorka1, P Anderlini, R Saliba
1Baylor College of Medicine Center for Cell and Gene Therapy, Houston, TX 77030, USA. donnap@bcm.cmc.edu
Insights
Chronic graft-vs-host disease (GVHD) affects many after HLA-identical stem cell transplants. Tacrolimus and methotrexate reduce risk, while acute GVHD increases it, impacting survival.
Area of Science:
- Hematology
- Immunology
- Oncology
Background:
- Chronic graft-vs-host disease (GVHD) is a significant complication following allogeneic hematopoietic stem cell transplantation.
- Understanding its incidence, risk factors, and impact is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the incidence, characteristics, risk factors, and impact of chronic GVHD in recipients of HLA-identical blood stem cell transplants.
- To identify clinical factors influencing the development and severity of chronic GVHD.
Main Methods:
- A consecutive series of 116 evaluable HLA-identical blood stem cell transplant recipients were analyzed.
- Minimum follow-up was 18 months, with assessment of chronic GVHD incidence and risk factors.
Main Results:
- The cumulative incidence of chronic GVHD was 57%, with extensive chronic GVHD in 71% of recipients.
- Tacrolimus and methotrexate prophylaxis was associated with reduced chronic GVHD risk (HR, 0.35), while prior acute GVHD increased risk (HR, 1.67).
- High-risk chronic GVHD adversely impacted overall mortality (HR, 6.6) and treatment failure (HR, 5.2) at 18 months.
Conclusions:
- There is a substantial rate of chronic GVHD after HLA-identical allogeneic blood stem cell transplantation.
- Clinical factors, including GVHD prophylaxis and prior acute GVHD, significantly alter the risk of chronic GVHD.
- High-risk chronic GVHD has a detrimental effect on patient outcomes, including mortality and treatment failure.
Abstract:
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.