Risk Factors for Graft-Versus-Host Disease After Transplantation of Hematopoietic Stem Cells from Unrelated Donors in the China Marrow Donor Program

Abstract

BackgroundWe identified risk factors for acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively) in recipients after hematopoietic stem cell transplantation (HSCT) from unrelated donors in the China Marrow Donor Program (CMDP).Material/MethodsWe analyzed follow-up clinical information from 1824 patients who underwent HSCT between 2001 and 2010.ResultsThe incidence of aGVHD and cGVHD after transplantation was 49.29% and 27.3%, respectively. aGVHD incidence decreased as HLA matching increased (p<0.001). Incidence of aGVHD and cGVHD was higher in 2 HLA-A locus donor/recipient groups (02: 01/02: 06 and 02: 01/02: 07; p≤0.022). aGVHD incidence was associated with patient age, absence of rabbit anti-thymocyte globulin (ATG) pretreatment, and disease status (p≤0.040). aGVHD appeared to be a risk factor for cGVHD, and total body irradiation (TBI) was also associated with cGVHD. Patients with cGVHD after transplantation had a higher survival rate than patients without cGVHD (p<0.001), which may be due to reduced relapse rates. Survival was also associated with ATG prophylaxis and disease status.ConclusionsThe incidence of GVHD after HSCT from unrelated donors in the Chinese population is similar to the results reported from other countries. A high degree of HLA matching, a conditioning regimen without TBI, and the use of ATG may reduce the incidence of aGVHD.

Occurrence and Severity of Donor Lymphocyte Infusion–Associated Chronic Graft-versus-Host Disease Influence the Clinical Outcomes in Relapsed Acute Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation

“…We observed that aGVHD after Chemo-DLI was not associated with the cGVHD after Chemo-DLI. It is somewhat to our surprise because aGVHD was 1 of the most important risk factors for the occurrence of cGVHD [44,45]. We suggested that patients who experienced aGVHD after Chemo-DLI should receive immunotherapies until the aGVHD was controlled.…”

Cannabidiol Enhances Intestinal Cannabinoid Receptor Type 2 Receptor Expression and Activation Increasing Regulatory T Cells and Reduces Murine Acute Graft-versus-Host Disease without Interfering with the Graft-versus-Leukemia Response

“…The pathophysiology of aGVHD is complex and involves several inflammatory cytokines, whose release starts during the conditioning regimen (irradiation and/or chemotherapy), leading to a pro-inflammatory environment that promotes T cell activation, proliferation, and differentiation against target organs (Schroeder et al, 2011). About 50% of patients with GVHD will die because of disease complications, and this is matched only by aGVHD's high incidence rate among patients who undergo alloHSCT (Barton-Burke et al, 2008;Yang et al, 2017). Although alloHSCT leads to a higher chance of developing aGVHD, it also provides a stronger graft-versus-tumor (GVT) reactivity, by which the new immune system recognizes and mediates the immunological eradication of reminiscent cancer cells (Noriega et al, 2015;van Bergen et al, 2017).…”

Phase 2 Study of Anti-Human Cytomegalovirus Monoclonal Antibodies for Prophylaxis in Hematopoietic Cell Transplantation

“…GVHD, a known complication of allogeneic HCT, was observed in higher proportion in the CSJ148-treated patients. The reason for the higher rate in CSJ148-treated patients is not clear, although these patients were older, and older age is a risk factor for acute GVHD (22)(23)(24)(25)(26). Other imbalances in baseline characteristics may have also contributed to the higher proportion of graft-versus-host disease observed in CSJ148-treated patients.…”