Risk factors for acute GVHD and survival after hematopoietic cell transplantation

Madan Jagasia, Mukta Arora, Mary E. D. Flowers, Nelson J. Chao, Philip L. McCarthy, Corey S. Cutler, Alvaro Urbano-Ispizua, Steven Z. Pavletic, Michael D. Haagenson, Mei-Jie Zhang, Joseph H. Antin, Brian J. Bolwell, Christopher Bredeson, Jean-Yves Cahn, Mitchell Cairo, Robert Peter Gale, Vikas Gupta, Stephanie J. Lee, Mark Litzow, Daniel J. Weisdorf, Mary M. Horowitz and Theresa Hahn


Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for International Blood and Marrow Transplant Research, Minneapolis, MN. To understand the impact of transplant regimen on AGVHD risk, 6 treatment categories were evaluated: (1) myeloablative conditioning (MA) with total body irradiation (TBI) + PBSCs, (2) MA + TBI + BM, (3) MA + nonTBI + PBSCs, (4) MA + nonTBI + BM, (5) reduced intensity conditioning (RIC) + PBSCs, and (6) RIC + BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval [CI], 37%-41%) in the SD cohort and 59% (95% CI, 57%-61%) in the URD cohort. Patients receiving SD transplants with MA + nonTBI + BM and RIC + PBSCs had significantly lower risks of grades B-D AGVHD than patients in other treatment categories. Those receiving URD transplants with MA + TBI + BM, MA + nonTBI + BM, RIC + BM, or RIC + PBSCs had lower risks of grades B-D AGVHD than those in other treatment categories. The 5-year probabilities of survival were 46% (95% CI, 44%-49%) with SD transplants and 33% (95% CI, 31%-35%) with URD transplants. Conditioning intensity, TBI and graft source have a combined effect on risk of AGVHD that must be considered in deciding on a treatment strategy for individual patients.

  • Submitted June 28, 2011.
  • Accepted October 4, 2011.
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