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Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a

Gabriel Afram1, Jose Antonio Pérez Simón2, Mats Remberger3

  • 1Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden. gabriel.afram@ki.se.

Medical Oncology (Northwood, London, England)
|April 27, 2018
PubMed

Insights

Chronic graft-versus-host disease (cGVHD) after stem cell transplant is linked to older age, prior acute GVHD, and reduced intensity conditioning. Antithymocyte globulin (ATG) reduces cGVHD risk without impacting survival.

Area of Science:

  • Hematopoietic Stem Cell Transplantation (HSCT)
  • Immunology
  • Oncology

Background:

  • Chronic graft-versus-host disease (cGVHD) is a significant complication following allogeneic HSCT, leading to substantial morbidity and mortality.
  • Identifying risk factors for cGVHD is crucial for improving patient outcomes and tailoring prophylactic strategies.

Purpose of the Study:

  • To identify key risk factors associated with the development of cGVHD in a multicenter setting.
  • To evaluate the impact of specific factors, including conditioning intensity and donor-recipient characteristics, on cGVHD incidence and severity.

Main Methods:

  • Retrospective analysis of 820 patients undergoing allogeneic HSCT between 2000 and 2006.
  • Data collected on patient demographics, donor types, conditioning regimens (including reduced intensity conditioning - RIC), and GVHD prophylaxis.
  • Statistical analysis to determine hazard ratios (HR) and p-values for risk factors associated with overall and severe cGVHD.

Main Results:

  • Overall cGVHD incidence was 46% in patients surviving >100 days.
  • Risk factors for overall cGVHD included older patient age (HR 1.15), prior acute GVHD (aGVHD) (HR 1.30), and RIC (HR 1.36).
  • Severe cGVHD was associated with RIC (HR 4.85), prior aGVHD (HR 2.14), and female donor to male recipient (HR 1.80). Antithymocyte globulin (ATG) demonstrated a protective effect (HR 0.41 for overall, HR 0.20 for severe cGVHD).

Conclusions:

  • Reduced intensity conditioning, prior aGVHD, and female-to-male donation are significant risk factors for severe cGVHD.
  • ATG effectively reduces the risk of cGVHD across all grades without negatively impacting relapse-free survival (RFS).
  • GVHD prophylaxis strategies should be personalized based on individual patient risk profiles.

Keywords:
ATGGraft-versus-host disease (GVHD)Risk factor

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