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Treatment of moderate/severe acute graft-versus-host disease after
allogeneic bone marrow transplantation: an analysis of clinical risk
features and outcome
D Weisdorf, R Haake, B Blazar, W Miller, P McGlave, N Ramsay, J Kersey and A Filipovich
Bone Marrow Transplantation Program, University of Minnesota, Minneapolis.
We have analyzed the long term outcome of 197 patients who were treated for
grade II to IV acute graft-versus-host disease (GVHD) following
histocompatible allogeneic bone marrow transplantation (BMT). Of 469
recipients of sibling donor allografts performed at our center between
January, 1979 and October, 1987, 197 patients (42%) developed greater than
or equal to grade II acute GVHD at a median of 38 days (range 9 to 98 days)
post-BMT. After treatment with corticosteroids (n = 160) or other
immunosuppressive therapies (n = 37), 72 patients (41% +/- 8%; 95%
confidence interval [CI]) achieved complete and continuing resolution of
acute GVHD after a median of 21 days of therapy. Sixty- one patients
required additional immunosuppressive therapy with high dose
methylprednisolone, antithymocyte globulin (ATG)/steroids, or other
therapies because of refractory or progressive symptoms of acute GVHD.
Seven of these 61 patients eventually obtained complete and continuing
remission after 13 to 57 days (median 50) of secondary treatment. The
overall rate of chronic GVHD was 70% +/- 16%; 95% CI following grade II to
IV acute GVHD. Twenty-five of the 197 patients never developed chronic
GVHD, resulting in a Kaplan-Meier projection of 30% +/- 8% (95% CI) cure of
moderate/severe acute GVHD. Analysis of clinical features associated with
complete response (CR) to acute GVHD therapy identified more favorable
responses to therapy in patients without either liver or skin involvement,
patients with acute lymphoblastic leukemia, and donor/recipient pairs other
than male patients with female donors. Older recipient age was not
associated with more resistance to GVHD treatment. CR to GVHD treatment was
associated with significantly better 5-year survival: 51% +/- 14% versus
32% +/- 11% for patients with therapy resistant acute GVHD (P = .004). GVHD
was a major contributing cause of death in 49 of the 90 patients who died
and was often complicated by infection or interstitial pneumonitis. Control
of acute GVHD through immunosuppressive therapy did not affect the risk of
leukemic relapse after transplantation.
Volume 75,
Issue 4,
pp. 1024-1030,
02/15/1990
Copyright © 1990 by The American Society of Hematology
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