GRAFT-VERSUS-HOST DISEASE AFTER BONE MARROW TRANSPLANTATION FOR THALASSEMIA
- 27 March 1997
- journal article
- research article
- Published by Wolters Kluwer Health in Transplantation
- Vol. 63 (6), 854-860
- https://doi.org/10.1097/00007890-199703270-00011
Abstract
We analyzed risk factors in 724 patients evaluable for acute graft-versus-host disease (GVHD) and in 614 patients evaluable for chronic GVHD who had received bone marrow transplantation (BMT) from HLA-identical siblings and/or parents for thalassemia and/or microdrepanocytosis, in a single institution. The overall incidence of grade II-IV and III-IV acute GVHD (aGVHD) was 26.9% and 13.5%, respectively. The cumulative incidence of grade II-IV aGVHD in patients treated with cyclosporine (CsA)/methylprednisolone (MP) or CsA/methotrexate (MTX)/MP was 32% and 17%, respectively (P=0.001). In logistic regression analysis, the risk factors associated with the onset of grade II-IV aGVHD in the entire group of patients were: patient age ≤4 years (P=0.009), male patient sex (P=0.023), GVHD prophylaxis with CsA/MP or MTX/MP (P=0.000), more than twofold elevated alanine aminotransferase (P=0.001), and patient seropositivity for two to three herpes viruses (P=0.007). In patients treated with CsA/MP, splenomegaly >2 cm (P=0.042) and donor age ≥17 years (P=0.034) predicted aGVHD. Risk factors for grade III-IV aGVHD were similar to the risk factors identified for grade II-IV aGVHD. Moreover, moderate and severe liver fibrosis or cirrhosis predicted grade III-IV aGVHD (P=0.018). The incidence of chronic GVHD (cGVHD) was 27.3%. The probability of cGVHD at 2 years after BMT in patients with grade 0, I, II, and III-IV aGVHD was 15%, 32%, 53%, and 54%, respectively. Among patients with absent or grade I-IV aGVHD, prior aGVHD (P=0.000), female donor sex (P=0.000), use of alloimmune female donors for male patients (0.009), and GVHD prophylaxis with CsA/MP or MTX/MP (P=0.003) predicted cGVHD. This data should be considered in clinical management and in future investigations for improvement of immunosuppressive prophylaxis in BMT patients with thalassemia.Keywords
This publication has 31 references indexed in Scilit:
- Marrow Transplantation in Patients with Thalassemia Responsive to Iron Chelation TherapyNew England Journal of Medicine, 1993
- Prevention and Management of Graft-versus-Host DiseaseDrugs, 1993
- Bone marrow transplantation for thalassemia and other inherited disorders of hemoglobin [editorial]Blood, 1992
- Graft-versus-Host DiseaseNew England Journal of Medicine, 1991
- Bone Marrow Transplantation in Patients with ThalassemiaNew England Journal of Medicine, 1990
- Risk factors for acute graft‐versus‐host diseaseBritish Journal of Haematology, 1987
- Graft‐versus‐Host DiseaseImmunological Reviews, 1985
- Predictive factors for acute graft-versus-host disease in patients transplanted with HLA-identical bone marrowBlood, 1984
- Chronic graft-versus-host disease in 52 patients: adverse natural course and successful treatment with combination immunosuppressionBlood, 1981
- CLINICAL MANIFESTATIONS OF GRAFT-VERSUS-HOST DISEASE IN HUMAN RECIPIENTS OF MARROW FROM HL-A-MATCHED SIBLING DONOR,STransplantation, 1974