Risk assessment and outcome of chronic graft-versus-host disease after allogeneic peripheral blood progenitor cell transplantation in pediatric patients

Abstract

We evaluated the incidence, risk factors for cGvHD and clinical outcome in 80 pediatric patients (36 male and 44 female) (median age 13 years; range 1 to 18) who underwent allogeneic PBPC transplantation. All patients were grafted from an HLA-identical sibling after myeloablative conditioning (TBI-based 52; non-TBI 28). GvHD prophylaxis used were CsA+ short methotrexate in 52 and CsA± predinosone in 28. The median number of CD34+ cells infused was 5.8 x 106/Kg (range; 1.4–32.8). The median follow-up was 24 months (range; 3–94). Twenty-eight patients had cGvHD. The cumulative incidence of cGvHD at 24 months was 54.2±10%. Factors that were found significant on univariate analysis were diagnosis (p = 0.03) and GvHD prophylaxis used (p = 0.04). A trend to higher risk of cGvHD was found with higher numbers of CD34+ and CD3+ cells infused. On multivariate analysis, only the GvHD prophylaxis used other than CsA plus short MTX was associated with a significant risk of cGvHD (HR 3.94; 95% CI: 1.41–10.91, p = 0.009). The cumulative incidence of cGvHD for patients receiving MTX was 40.9±12% whereas for patients who did not received MTX was 76.5±18% (HR 2.39; 95% CI: 1.05–7.49; p = 0.03).