Chronic graft-versus-host disease after allogeneic blood stem cell transplantation: long-term results of a randomized study

Abstract

The use of peripheral blood stem cells (PBSCs) is rapidly growing in the allogeneic transplantation setting as an alternative to bone marrow (BM). We previously reported a higher incidence of chronic graft-versus-host disease (cGVHD) associated with allogeneic PBSC transplantation in a randomized trial. In this follow-up report, we analyzed the evolution of cGVHD in the patients (n ‫؍‬ 101) enrolled on this study. At a median follow-up of 45 months (range, 31-57 months), we found that the 3-year cumulative incidence of cGVHD was 65% (95% confidence interval [CI] 51%-78%) in the PBSC group and 36% (95% CI 23%-49%) in the BM group (P ‫؍‬ .004). We also found that extensive cGVHD was more frequent in the PBSC group (44% [95% CI 30%-58%] vs 17% [95% CI 7%-27%]; P ‫؍‬ .004). The prevalence of cGVHD was always higher in the PBSC arm. Ocular involvement was more frequent in PBSC recipients (P ‫؍‬ .02). Cutaneous and liver involvement was similar among BM and PBSC recipients. Chronic GVHD required multiple courses of immunosuppressive therapy in addition to cyclosporine and corticosteroids during longer periods (P ‫؍‬ .03). Altogether, this translated into longer periods of hospitalization after transplantation in the PBSC group (P ‫؍‬ .04). Finally, we also confirm that cGVHD after PBSC transplantation is associated with an antileukemic effect that is at least as potent as after BM. However, to date, this has not translated into a survival difference, possibly due to the early-stage leukemic status of these patients or to the relatively small size of the study population. (Blood. 2002;100: 3128-3134)

Prophylactic use of low-dose interleukin-2 and the clinical outcomes of hematopoietic stem cell transplantation: A randomized study

“…This increase was not significant, but our study was not sufficiently powered to detect an increase. cGVHD has been inversely correlated with relapse risk in acute leukemia in many studies 9,10 and in this study. Note: All data are given as incidence (95% CI) unless otherwise noted and were analyzed with Gray's method and a log-rank test.…”

Effective prevention of GVHD using in vivo T-cell depletion with anti-lymphocyte globulin in HLA-identical or -mismatched sibling peripheral blood stem cell transplantation

“…3,15 Although chronic GVHD is associated with a lower risk of relapse, it reduces the quality of life substantially. 5 The incidence of chronic GVHD is more frequent after peripheral blood stem cell than after bone marrow transplantation.…”

Filgrastim support in allogeneic HSCT for myeloid malignancies: a review of the role of G-CSF and the implications for current practice

“…G-CSF-mobilized stem cell grafts contain B1-log greater T cells than do conventional bone marrow harvests, but the incidence and severity of acute GVHD is similar, whereas chronic GVHD is increased. [33][34][35][36] Thus, G-CSF-mobilized stem cells or the use of G-CSF post transplant may affect immune reconstitution.…”