Blood Journal
Leading the way in experimental and clinical research in hematology

Risk factors for acute GVHD and survival after hematopoietic cell transplantation

  1. Madan Jagasia1,
  2. Mukta Arora2,
  3. Mary E. D. Flowers3,
  4. Nelson J. Chao4,
  5. Philip L. McCarthy5,
  6. Corey S. Cutler6,
  7. Alvaro Urbano-Ispizua7,
  8. Steven Z. Pavletic8,
  9. Michael D. Haagenson9,
  10. Mei-Jie Zhang10,
  11. Joseph H. Antin6,
  12. Brian J. Bolwell11,
  13. Christopher Bredeson12,
  14. Jean-Yves Cahn13,
  15. Mitchell Cairo14,
  16. Robert Peter Gale15,
  17. Vikas Gupta16,
  18. Stephanie J. Lee3,
  19. Mark Litzow17,
  20. Daniel J. Weisdorf2,
  21. Mary M. Horowitz10, and
  22. Theresa Hahn5
  1. 1Vanderbilt University Medical Center, Nashville, TN;
  2. 2University of Minnesota, Minneapolis, MN;
  3. 3Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA;
  4. 4Duke University Medical Center, Durham, NC;
  5. 5Roswell Park Cancer Institute, Buffalo, NY;
  6. 6Dana-Farber Cancer Institute, Boston, MA;
  7. 7Hospital Clinico, Barcelona, Spain;
  8. 8Experimental Transplantation and Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD;
  9. 9Center for International Blood and Marrow Transplant Research, Minneapolis, MN;
  10. 10Medical College of Wisconsin, Center for International Blood and Marrow Transplant Research, Milwaukee, WI;
  11. 11Cleveland Clinic Foundation, Cleveland, OH;
  12. 12The Ottawa Hospital Blood and Marrow Transplant Program, University of Ottawa, Ottawa, ON;
  13. 13Hospital A. Michallon, Centre de Hospitalier de Grenoble, Grenoble, France;
  14. 14New York Medical College, Columbia University Medical Center, New York, NY;
  15. 15Center for Advanced Studies in Leukemia, Los Angeles, CA;
  16. 16Princess Margaret Hospital, Toronto, ON; and
  17. 17Mayo Clinic, Rochester, MN


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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