Risk Factors for Steroid-Refractory Acute Graft-versus-Host Disease after Allogeneic Stem Cell Transplantation from Matched Related or Unrelated Donors

Abstract

We performed a retrospective study to identify pretransplantation risk factors for steroid-refractory (SR) acute graft-versus host disease (aGVHD) after allogeneic stem cell transplantation from matched donors in 630 adult patients who underwent transplantation at our center between 2000 and 2012. The cumulative incidence (CI) of SR aGVHD was 11.3% ± 2.3%. The identified independent risk factors were matched unrelated donor (hazard ratio [HR], 2.52; P = .001), female donor for male recipient (HR, 1.84; P = .023) and absence of antithymocyte globulin (HR, 2.02; P = .005). Three risk groups were defined according to the presence of these risk factors. In the whole cohort, the CI of SR aGVHD was 3.5% ± 1.7% in the low-risk group (0 risk factor, n = 115), 9.3% ± 1.6% in the intermediate-risk group (1 risk factor, n = 323), and 19.3% ± 2.9% in the high-risk group (2 or 3 risk factors, n = 192). Our study suggests that pretransplantation characteristics might help identify patients at high risk for SR aGVHD. A risk adapted first-line treatment of aGVHD could be evaluated in those patients.

HLA-C KIR-Ligands Determine the Impact of Anti-Thymocyte Globulin (ATG) on Graft versus Host and Graft versus Leukemia Effects Following Hematopoietic Stem Cell Transplantation

“…Our findings furthermore indicate that ATG may operate through paving the way toward better manageability, facilitating steroid- (or treatment-) responsiveness of aGVHD, as previously suggested [8], rather than by simply reducing its numerical incidence. This property should be considered for designing studies and declaring endpoints in future (prospective) research on the effects of ATG serotherapy in HSCT.…”

“…Despite this, the occurrence of severe GVHD, particularly severe aGVHD, is hardly predictable in an individual transplant. Even less, the development of steroid-refractory aGVHD can be accurately predicted at the time of HSCT, although sex mismatched female donor, unrelated donor, and absence of ATG have been described as risk factors [8]. Therefore, more precise estimation of the individual GVHD risk will likely help improve algorithms on when and how to intensify GVHD prophylaxis by incorporation of ATG.…”

Angiogenic factors and inflammation in steroid-refractory acute graft-vs-host disease

“…Steroid-refractory acute graft-versus-host disease (aGVHD) is a life-threatening complication of allogeneic hematopoietic cell transplantation (HCT) affecting 11% of transplant recipients [1]. In this condition, an immunocompromised host’s organs are attacked by immunocompetent lymphocytes from the donor graft without clinical improvement after the accepted first-line therapy, corticosteroids.…”

Small Bowel Perforation Associated With Gastrointestinal Graft-Versus-Host Disease and Cytomegalovirus Enteritis in a Patient With Leukemia: A Case Report With Literature Review

“…Severe gastrointestinal GVHD is associated with a poor prognosis [ 11 , 12 ], which is worsened in those presenting with concomitant CMV gastroenteritis [ 4 ]. Additionally, most patients have an immune-compromised and poor general condition.…”