Risk factors for chronic graft-versus-host disease after bone marrow transplantation: a retrospective single centre analysis

Abstract

Summary:Among 551 consecutive recipients of allogeneic bone marrow transplants, 451 survived more than 3 months and were evaluated for chronic graft-versus-host disease (GVHD). Most of the donors were HLA-identical siblings or parents (n = 334). Patients with HLA-mismatched donors (n = 30) and matched unrelated donors (MUD) (n = 87) were also included in the study. In the analysis of all patients, the 5-year cumulative incidence of chronic GVHD was 45%. We analysed 34 risk factors. High recipient age was the single most important risk factor (P Ͻ 0.001). Other significant risk factors in multivariate analysis were: acute GVHD grades I-IV (P Ͻ 0.001), immune female donor to male recipient (P = 0.006) and chronic myelogenous leukaemia (CML), compared with all other diagnoses (P = 0.014). The cumulative 5-year incidence of chronic GVHD, with no significant risk factors present, was 9%, 29% with one risk factor, 53% with two, 68% with three and 75% with all four risk factors present. In patients with HLAidentical sibling donors and GVHD prophylaxis consisting of a combination of methotrexate (MTX) and cyclosporin A (CsA) (n = 208), increasing recipient age (P Ͻ 0.001) and CML (P = 0.007), were found to be significant risk factors for chronic GVHD. Finally, a multivariate analysis in recipients of bone marrow from unrelated donors (n = 89) showed recipient age alone (P = 0.006) to be significantly associated with chronic GVHD.

Incidence and risk factors for ocular GVHD after allogeneic hematopoietic stem cell transplantation

“…22,24 Regarding risk factors for ocular GVHD, several studies have suggested that prior acute skin GVHD was an independent predictor for ocular GVHD, 10,12 and we also observed that skin involvement during the acute and chronic stages was correlated with the onset of ocular GVHD. During the acute and chronic stages, GVHD in the gastrointestinal tract and liver was also correlated with the occurrence of ocular GVHD, as was GVHD in the oral mucosa and lungs during the chronic stage.…”

“…A history of acute GVHD is known to be a strong risk factor for chronic GVHD development, [21][22][23][24] and other risk Values are n (%) unless otherwise specified.…”

Donor–recipient gender difference affects severity of dry eye after hematopoietic stem cell transplantation

“…21 Besides the T cells, antibodies against the H-Y antigen made by donor B cells probably also contribute to GVHD. 21,22 There are some reports that male recipients whose female donors had previous pregnancies or blood transfusions are at increased risk of developing GVHD, [23][24][25] apparently because of B-cell sensitization to the H-Y antigen. In this study, the previous donor pregnancies and transfusions was not checked.…”

Risk factors and organ involvement of chronic GVHD in Japan

“…2,3 Several studies have reported a history of acute GVHD to be a strong risk factor that is consistently associated with chronic GVHD development. [4][5][6][7][8] Other identified risk factors include the following: female donor and male recipient, 4,6 use of PBSC grafts, 6,9-13 older patient, 4,[6][7][8] older donor, 6,7 transplantation from a mismatched or unrelated donor, 5,6,14 diagnosis of CML 4,7,8 and absence of anti-thymocyte globulin (ATG) use. 15 The number of unrelated cord blood (U-CB) transplantations performed has rapidly increased during the past decade.…”