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Risk factors for chronic graft-versus-host disease after HLA-identical
sibling bone marrow transplantation
K Atkinson, MM Horowitz, RP Gale, DW van Bekkum, E Gluckman, RA Good, N Jacobsen, HJ Kolb, AA Rimm and O Ringden
International Bone Marrow Transplant Registry, Medical College of
Wisconsin, Milwaukee 53226.
Chronic graft-versus-host disease (GVHD) is an important complication of
bone marrow transplantation. We analyzed risk factors for chronic GVHD in
2,534 recipients of HLA-identical sibling transplants surviving at least 90
days after transplantation. The actuarial probability of developing chronic
GVHD within three years posttransplant was 46% +/- 3% (95% confidence
interval). The most important risk factor for chronic GVHD was acute GVHD.
The 3-year probabilities of chronic GVHD were 28% +/- 3%, 49% +/- 5%, 59%
+/- 6%, 80% +/- 9%, and 85% +/- 15% for persons with grades 0, I, II, III,
and IV acute GVHD, respectively (P less than .0001). Among patients with no
or grade I acute GVHD, recipient age greater than 20 years, use of
non-T-cell depleted bone marrow, and alloimmune female donors for male
recipients predicted a higher risk of chronic GVHD. When all three adverse
risk factors were present, the probability of chronic GVHD was 62% among
persons with no prior acute GVHD and 85% among those with grade I acute
GVHD. Among patients with grade II through IV acute GVHD, no other risk
factor predicted chronic GVHD. These data identify individuals who might
benefit from treatment strategies aimed at changing the incidence of
chronic GVHD.
Volume 75,
Issue 12,
pp. 2459-2464,
06/15/1990
Copyright © 1990 by The American Society of Hematology
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