Chronic graft-versus-host disease after allogeneic peripheral blood progenitor cell or bone marrow transplantation from matched related donors. A case-control study

Abstract

Summary:We retrospectively compared the incidence and clinical characteristics of cGVHD in 37 allo-PBT recipients transplanted between July 1994 and October 1996 and 37 historical control allo-BMT recipients in a casecontrol study. All patients received a first unmanipulated transplant, graft from an HLA-identical sibling donor, with CsA-MTX GVHD prophylaxis and survived more than 100 days after transplant. PBT and BMT groups were well matched for age, grade of acute GVHD, male patients grafted from female donors, and phase of disease. The median CD34 + and CD3 + cell numbers infused in the PBT group were 5.2 × 10 6 /kg and 307 × 10 6 /kg, respectively. The median time to an ANC greater than 0.5 × 10 9 /l was 16 days (range 11-22) after PBT and 22 days (range 14-36) after BMT (P Ͻ 0.001). The median time to a platelet count greater than 20 × 10 9 /l was 15 days (range 6-43) after PBT and 28 days (range 12-68) after BMT (P Ͻ 0.001). Median follow-up was 12.3 months (range 5.4-30.3) and 58.7 months (range 4-122.3), for patients receiving PBT and BMT, respectively. Seventeen out of 37 (46%) PBT recipients, vs nine out of 37 (24%) BM recipients developed cGVHD. Actuarial probability of cGVHD at 1 year was 59% (95% CI, 39-79) in the PBT group vs 27% (95% CI, 12-42) in the BM group (P = 0.01). Cumulative incidence estimate of cGVHD was 51% and 25%, for patients receiving PBT and BMT respectively (P = 0.03). Clinical characteristics of cGVHD and response to therapy were similar in both groups, except for a higher incidence of de novo cGVHD in the PBT group. Our results suggest that as compared with BMT, PBT may result in an increased incidence of cGVHD.

Clinical and economic comparison of allogeneic peripheral blood progenitor cell and bone marrow transplantation for acute lymphoblastic leukemia in children

“…There is no definitive evidence of a higher incidence and severity of acute GVHD in PBPCT, but there are some reports suggesting a higher incidence of chronic GVHD. 7,9,16 Although experience in children is limited, in our study we found no differences in the incidence of grade уII acute or chronic GVHD between the PBPCT and BMT groups.…”

“…13,14 Although a high incidence of chronic graft-versus-host disease (GVHD) has been observed after PBPC transplantation, the higher numbers of CD3 + and natural killer (NK) cells in the graft may enhance the graft-versus-leukemia (GVL) effect. 8,15,16 Furthermore, PBPCT has been reported to cost less than BMT. 17 We compared the engraftment kinetics, incidence of acute and chronic GVHD, outcome and economic costs of allogeneic PBPCT vs BMT for children with ALL in a single institution.…”

Prophylaxis of graft-versus-host disease with cyclosporine–prednisone is associated with increased risk of chronic graft-versus-host disease

“…An increased incidence of chronic GVHD has been associated with allogeneic peripheral stem cell transplants, compared with that of allogeneic BMT, in several case control studies, but PRED was part of the GVHD prophylactic regimen in only one of these studies. [45][46][47][48] …”

Repeated course of rituximab for treatment of nephrotic syndrome in patients with chronic GVHD

“…Its incidence may increase with the increase in age of transplant recipients, donor lymphocyte infusion and the increase in use of blood stem cell grafts. [1][2][3] In a report published in 2006, nine patients with chronic GVHD-associated nephrotic syndrome were studied. 4 Two out of these nine patients received rituximab therapy with an excellent response.…”