Abstract
Chronic graft-versus-host disease (cGVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Aim is to identify risk factors for the development of cGVHD in a multicenter setting. Patients transplanted between 2000 and 2006 were analyzed (n = 820). Donors were HLA-identical siblings (57%), matched unrelated donors (30%), and HLA-A, B or DR antigen mismatched (13%). Reduced intensity conditioning (RIC) was given to 65% of patients. Overall incidence of cGVHD was 46% for patients surviving more than 100 days after HSCT (n = 747). Older patient age [HR 1.15, p < 0.001], prior acute GVHD [1.30, p = 0.024], and RIC [1.36, p = 0.028] increased overall cGVHD. In addition, RIC [4.85, p < 0.001], prior aGVHD [2.14, p = 0.001] and female donor to male recipient [1.80, p = 0.008] increased the risk of severe cGVHD. ATG had a protective effect for both overall [0.41, p < 0.001] and severe cGVHD [0.20, p < 0.001]. Relapse-free survival (RFS) was impaired in patients with severe cGVHD. RIC, prior aGVHD, and female-to-male donation increase the risk of severe cGVHD. ATG reduces the risk of all grades of cGVHD without hampering RFS. GVHD prophylaxis may be tailored according to the risk profile of patients.
Highlights
Chronic graft-versus-host disease remains one of the most severe complications after allogeneic hematopoietic stem cell transplantation (HSCT), affecting both the quality of life and mortality of long-term survivors [1,2,3,4]
Proper management of patients should be based on individualized strategies taking into account the notion that the absence of Chronic graft-versus-host disease (cGVHD) might hamper relapse-free survival while severe cGVHD leads to increased mortality due to infectious complications and organ failure [15,16,17,18]
We identified risk factors with regard to developing severe cGVHD, including female donor-tomale donor recipient, prior aGVHD and use of reduced intensity conditioning
Summary
Chronic graft-versus-host disease (cGVHD) remains one of the most severe complications after allogeneic hematopoietic stem cell transplantation (HSCT), affecting both the quality of life and mortality of long-term survivors [1,2,3,4]. Its impact on morbidity and mortality varies depending on the severity and number of organs involved, allowing the classification of patients into mild, moderate, and severe cGVHD according to the NIH, and identifying those at low, intermediate, or high risk of developing GVHD-related morbidity and mortality. Chronic GVHD is associated with a graft-versustumor effect (GVT) that decreases the risk of relapse after transplant [5]. These findings emphasize the importance of appropriate management of cGVHD, which should be individualized according to the patients’ characteristics. Risk factors for cGVHD include high recipient age, prior acute GVHD, female donor to male recipient [6], HLA disparity between recipient and donor, and use of peripheral blood as a source of progenitor cells [7,8,9]. CGVHD is an increasingly frequent complication after HSCT due, at least
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