PURPOSE: Acute graft-versus-host disease (GVHD) causes substantial morbidity and mortality after human leukocyte antigen (HLA)-identical sibling transplants. No large registry studies of acute GVHD risk factors have been reported in two decades. Risk factors may have changed in this interval as transplant-related techniques have evolved. PATIENTS AND METHODS: Acute GVHD risk factors were analyzed in 1,960 adults after HLA-identical sibling myeloablative transplant for acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), or chronic myeloid leukemia (CML) reported by 226 centers worldwide to the Center for International Blood and Marrow Transplant Research from 1995 to 2002. Outcome was measured as time from transplant to onset of grade 2 to 4 acute GVHD, with death without acute GVHD as a competing risk. RESULTS: Cumulative incidence of grade 2 to 4 acute GVHD was 35% (95% CI, 33% to 37%). In multivariable analyses, factors significantly associated with grade 2 to 4 acute GVHD were cyclophosphamide + total-body irradiation versus busulfan + cyclophosphamide (relative risk [RR] = 1.4; P < .0001), blood cell versus bone marrow grafts in patients age 18 to 39 years (RR = 1.43; P = .0023), recipient age 40 and older versus age 18 to 39 years receiving bone marrow grafts (RR = 1.44; P = .0005), CML versus AML/ALL (RR = 1.35; P = .0003), white/Black versus Asian/Hispanic race (RR = 1.54; P = .0003), Karnofsky performance score less than 90 versus 90 to 100 (RR = 1.27; P = .014), and recipient/donor cytomegalovirus-seronegative versus either positive (RR = 1.20; P = .04). Stratification by disease showed the same significant predictors of grade 2 to 4 acute GVHD for CML; however, KPS and cytomegalovirus serostatus were not significant predictors for AML/ALL. CONCLUSION: This analysis confirmed several previously reported risk factors for grade 2 to 4 acute GVHD. However, several new factors were identified whereas others are no longer significant. These new data may facilitate individualized risk estimates and raise several interesting biologic questions.
PURPOSE: Acute graft-versus-host disease (GVHD) causes substantial morbidity and mortality after human leukocyte antigen (HLA)-identical sibling transplants. No large registry studies of acute GVHD risk factors have been reported in two decades. Risk factors may have changed in this interval as transplant-related techniques have evolved. PATIENTS AND METHODS: Acute GVHD risk factors were analyzed in 1,960 adults after HLA-identical sibling myeloablative transplant for acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), or chronic myeloid leukemia (CML) reported by 226 centers worldwide to the Center for International Blood and Marrow Transplant Research from 1995 to 2002. Outcome was measured as time from transplant to onset of grade 2 to 4 acute GVHD, with death without acute GVHD as a competing risk. RESULTS: Cumulative incidence of grade 2 to 4 acute GVHD was 35% (95% CI, 33% to 37%). In multivariable analyses, factors significantly associated with grade 2 to 4 acute GVHD were cyclophosphamide + total-body irradiation versus busulfan + cyclophosphamide (relative risk [RR] = 1.4; P < .0001), blood cell versus bone marrow grafts in patients age 18 to 39 years (RR = 1.43; P = .0023), recipient age 40 and older versus age 18 to 39 years receiving bone marrow grafts (RR = 1.44; P = .0005), CML versus AML/ALL (RR = 1.35; P = .0003), white/Black versus Asian/Hispanic race (RR = 1.54; P = .0003), Karnofsky performance score less than 90 versus 90 to 100 (RR = 1.27; P = .014), and recipient/donor cytomegalovirus-seronegative versus either positive (RR = 1.20; P = .04). Stratification by disease showed the same significant predictors of grade 2 to 4 acute GVHD for CML; however, KPS and cytomegalovirus serostatus were not significant predictors for AML/ALL. CONCLUSION: This analysis confirmed several previously reported risk factors for grade 2 to 4 acute GVHD. However, several new factors were identified whereas others are no longer significant. These new data may facilitate individualized risk estimates and raise several interesting biologic questions.
Authors: E Holler; H J Kolb; A Möller; J Kempeni; S Liesenfeld; H Pechumer; W Lehmacher; G Ruckdeschel; B Gleixner; C Riedner Journal: Blood Date: 1990-02-15 Impact factor: 22.113
Authors: Jerzy Wojnar; Sebastian Giebel; Malgorzata Krawczyk-Kulis; Mirosław Markiewicz; Tomasz Kruzel; Iwona Wylezol; Tomasz Czerw; Marek Seweryn; Jerzy Holowiecki Journal: Ann Transplant Date: 2006 Impact factor: 1.530
Authors: C Anasetti; P G Beatty; R Storb; P J Martin; M Mori; J E Sanders; E D Thomas; J A Hansen Journal: Hum Immunol Date: 1990-10 Impact factor: 2.850
Authors: R P Gale; M M Bortin; D W van Bekkum; J C Biggs; K A Dicke; E Gluckman; R A Good; R G Hoffmann; H E Kay; J H Kersey Journal: Br J Haematol Date: 1987-12 Impact factor: 6.998
Authors: R E Champlin; N Schmitz; M M Horowitz; B Chapuis; R Chopra; J J Cornelissen; R P Gale; J M Goldman; F R Loberiza; B Hertenstein; J P Klein; E Montserrat; M J Zhang; O Ringdén; S C Tomany; P A Rowlings; M E Van Hoef; A Gratwohl Journal: Blood Date: 2000-06-15 Impact factor: 22.113
Authors: N Jacobsen; J H Badsberg; B Lönnqvist; O Ringdén; L Volin; J Rajantie; J Nikoskelainen; N Keiding Journal: Bone Marrow Transplant Date: 1990-06 Impact factor: 5.483
Authors: K M Sullivan; K J Kopecky; J Jocom; L Fisher; C D Buckner; J D Meyers; G W Counts; R A Bowden; F B Peterson; R P Witherspoon Journal: N Engl J Med Date: 1990-09-13 Impact factor: 91.245
Authors: R Storb; R L Prentice; C D Buckner; R A Clift; F Appelbaum; J Deeg; K Doney; J A Hansen; M Mason; J E Sanders; J Singer; K M Sullivan; R P Witherspoon; E D Thomas Journal: N Engl J Med Date: 1983-02-10 Impact factor: 91.245
Authors: Aristeidis Chaidos; Scott Patterson; Richard Szydlo; Mohammed Suhail Chaudhry; Francesco Dazzi; Edward Kanfer; Donald McDonald; David Marin; Dragana Milojkovic; Jiri Pavlu; John Davis; Amin Rahemtulla; Katy Rezvani; John Goldman; Irene Roberts; Jane Apperley; Anastasios Karadimitris Journal: Blood Date: 2012-02-27 Impact factor: 22.113
Authors: S Fuji; S W Kim; S Yano; S Hagiwara; H Nakamae; M Hidaka; T Ito; K Ohashi; K Hatanaka; A Takami; S Kurosawa; T Yamashita; T Yamaguchi; T Fukuda Journal: Bone Marrow Transplant Date: 2015-11-09 Impact factor: 5.483
Authors: 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; Theresa Hahn Journal: Blood Date: 2011-10-18 Impact factor: 22.113
Authors: A B M Lim; J Storek; A Beligaswatte; M Collins; M Tacey; T Williamson; K Mason; E Li; M A Chaudhry; J A Russell; A Daly; J Szer; I Lewis; D Ritchie Journal: Bone Marrow Transplant Date: 2015-02-02 Impact factor: 5.483
Authors: Antonia M S Müller; Jessica A Linderman; Mareike Florek; David Miklos; Judith A Shizuru Journal: Proc Natl Acad Sci U S A Date: 2010-08-02 Impact factor: 11.205
Authors: Christiane Dobbelstein; Kwang Woo Ahn; Michael Haagenson; Gregory A Hale; Jon J van Rood; David Miklos; Edmund K Waller; Stephen R Spellman; Marcelo Fernandez-Vina; Arnold Ganser; Mahmoud Aljurf; Martin Bornhaeuser; Vikas Gupta; Susan R Marino; Marilyn S Pollack; Vijay Reddy; Matthias Eder; Stephanie J Lee Journal: Biol Blood Marrow Transplant Date: 2013-02-01 Impact factor: 5.742