Related factor analysis of graft-versus-host disease post nonmyeloablative stem cell transplantation

Abstract

Objective To explore and analyze the related factors of graft-versus-host disease (GVHD) post nonmyeloablative stem cell transplantation (NST) for haematologic diseases.Methods Thirty-four patients including severe aplastic anemia (SAA) (n=15),halassemia major (TM) (n=1) and malignant haematologie diseases (n=18) underwent unrelated umbilical cord blood transplantation (UCBT) (n=11) and sibling donor bone and peripheral blood stem cell transplantation (PBSCT) (n=7) or PBSCT (n=16).Nonmyeloablative conditioning regimens consisted of intensive immunosuppression based on anti-themocyte globulin (ATG),nti-T-lymphocyte globulin (ALG) or fludarabine.GVHD prophylaxis mainly consisted of short course methotrexate and eyclosporine (CsA).Clinical characteristics,nd acute and chronic GVHD were observed.The correlative factors of cGVHD were analyzed.Results Thirty-one (91.2%) patients achieved successful engraftment.In 7 malignant haematologic patients after transplantation,C occurred and after 2 to 9 procedures of DLI,C in 5 cases was turned to FDC.During the median duration of 12 months follow-up,5 patients suffered from acute GVHD of degree Ⅰ to Ⅱ,nd 15 patients from cGVHl3.Statistical analysis showed those patients who received NST-based ATG followed by DLI were characterized with high-rate of cGVHD and infection,nd poor response to treatment.However,n the patients with cGVHD receiving NST-based fludarabine the response to treatment was satisfactory.There were 3 and 5 deaths before and 100 days after transplantation,espectively,nd among them, patients died from cGVHD. Conclusion The risk factors of cGVHD post NST included age complications,ATC-base preconditioning regimen and malignant hematologic diseases. Key words: Graft vs host disease; Haematopoietic stem cell transplantation