Risk factors for acute graft-versus-host disease after allogeneic blood stem cell transplantation.

TitleRisk factors for acute graft-versus-host disease after allogeneic blood stem cell transplantation.
Publication TypeJournal Article
Year of Publication1999
AuthorsPrzepiorka D, Smith TL, Folloder J, Khouri I, Ueno NT, Mehra R, Körbling M, Huh YO, Giralt S, Gajewski J, Donato M, Cleary K, Claxton D, Braunschweig I, vanBesien K, Andersson BS, Anderlini P, Champlin R
Pagination1465 - 70
Date PublishedAug
Accession Number10438735
KeywordsAdolescent, Adult, Aged, Child, Female, Graft vs Host Disease, Hematopoietic Stem Cell Transplantation, Histocompatibility Testing, HLA Antigens, Humans, Immunosuppressive Agents, Male, Middle Aged, Risk Factors, Transplantation, Homologous

We evaluated demographic characteristics and graft composition as risk factors for acute graft-versus-host disease (GVHD) in 160 adult recipients of HLA-identical allogeneic blood stem cell transplants. The patients received a median nucleated cell dose of 7.9 x 10(8)/kg and median C34(+) cell dose of 5.6 x 10(6)/kg. GVHD prophylaxis consisted of cyclosporine (CSA) and steroids, tacrolimus (FK506) and steroids, or FK506 and methotrexate. Grades 2 to 4 GVHD occurred in 31% (95% CI, 23% to 39%), and grades 3 to 4 GVHD in 14% (95% CI, 8% to 20%). In univariate analyses, GVHD prophylaxis with CSA and high CD34(+) cell doses were significant risk factors for grades 2 to 4 GVHD, but diagnosis, age, use of total body irradiation, donor sex, female donor for male recipient, donor parity, donor alloimmunization, viral serology, nucleated cell dose, CD3(+) cell dose, and CD56(+) cell dose did not alter the incidence of GVHD significantly. With a CD34(+) cell dose less than 8 x 10(6) CD34(+) cells/kg, the risk of grades 2 to 4 GVHD was significantly higher for those who received CSA (39%, 95% CI, 21% to 47%) in comparison with those on FK506 (18%, 95% CI, 10% to 26%) (P =.03), but GVHD prophylaxis regimen had less impact with a higher CD34(+) cell dose (overall grades 2 to 4 GVHD rate 52%, 95% CI, 37% to 67%). GVHD prophylaxis and CD34(+) cell dose are independent risk factors for acute GVHD after allogeneic blood stem cell transplantation.

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