Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppression

Abstract

Fifty-two of 175 (30%) survivors of allogeneic marrow transplantation developed chronic graft-versus-hose diseases (GVHD). Five with limited chronic GVHD had an indolent clinical course with involvement of only the skin and liver. Forty-seven with extensive chronic GVHD had an unfavorable multiorgan disorder that resembled several autoimmune diseases. Thirteen patients with extensive disease (group I) were not treated and only 2 survive with Karnofsky scores >- 70%. Mortality resulted from infections and morbidity from sica syndrome, pulmonary and hepatic insufficiency, scleroderma-like skin disease, and contractures. Another 13 (group II) received a median of 8 mo prednisone and/or a brief course of antithymocyte globulin, and 3 survive without disability. The other 21 (group III) were treated with a combination of prednisone (1.0 mg/kg/q.o.d.) and either cyclophosphamide, procarbazine, or azathioprine (all 1.5 mg/kg/day) for a median of 13 mo. Combination therapy was well tolerated with only modest myelotoxicity. Fifteen in group III had a good and 4 a fair response to treatment while 2 with no response died. Azathioprine and prednisone was the most effective regimen. All therapy has been discontinued in 12 group III patients: GVHD returned in 5 (including 2 who died in spite of retreatment) while 7 remain free of GVHD for a median of 11 (range 6–30) mo observation. Only I group III survivor is disabled and 16 of the original 21 are alive 2–4 yr after transplant with Karnofsky scores of 70%-100%. Thus, combination immmunosuppression appears to favorably affect and, in some cases, premanently arrest the adverse natural course of extensive chronic GVHD.

Airflow Decline after Myeloablative Allogeneic Hematopoietic Cell Transplantation: The Role of Community Respiratory Viruses

“…Acute graft-versushost disease (GVHD) was graded using standard criteria [5] and was categorized as yes-acute GVHD (grades [3][4] or noacute GVHD (grades 0-2). The diagnosis and staging of chronic GVHD were established using previously published criteria [6]. Acute and chronic classes of GVHD were then integrated and categorized as no-acute GVHD or chronic GVHD, acute GVHD alone, de novo chronic GVHD (not preceded by acute GVHD), and chronic GVHD (preceded by acute GVHD that was or was not followed by a period of quiescence).…”

Association of bone marrow natural killer cell dose with neutrophil recovery and chronic graft‐versus‐host disease after HLA identical sibling bone marrow transplants

“…Other outcomes. Acute and chronic GvHDs were diagnosed and graded according to published criteria (Glucksberg et al, 1974;Shulman et al, 1980;Sullivan et al, 1981). All patients were considered evaluable for acute GvHD at day +1 after transplantation.…”

Mast cells, eosinophils and fibrosis

“…Chronic GVHD is a major complication of allogeneic bone marrow transplantation (BMT), which occurs with an incidence of up to 30%. It is believed to result from the reaction of donor immunocompetent T cells against alloreactive antigens of the host [33]. Chronic GVHD both in humans and in murine models is an autoimmune-like phenomenon, resembling idiopathic scleroderma [34][35][36].…”