Title |
Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting
|
---|---|
Published in |
Medical Oncology, April 2018
|
DOI | 10.1007/s12032-018-1127-2 |
Pubmed ID | |
Authors |
Gabriel Afram, Jose Antonio Pérez Simón, Mats Remberger, Teresa Caballero-Velázquez, Rodrigo Martino, Jose Luis Piñana, Olle Ringden, Albert Esquirol, Lucia Lopez-Corral, Irene Garcia, Oriana López-Godino, Jordi Sierra, Dolores Caballero, Per Ljungman, Lourdes Vazquez, Hans Hägglund |
Abstract |
Chronic graft-versus-host disease (cGVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Aim is to identify risk factors for the development of cGVHD in a multicenter setting. Patients transplanted between 2000 and 2006 were analyzed (n = 820). Donors were HLA-identical siblings (57%), matched unrelated donors (30%), and HLA-A, B or DR antigen mismatched (13%). Reduced intensity conditioning (RIC) was given to 65% of patients. Overall incidence of cGVHD was 46% for patients surviving more than 100 days after HSCT (n = 747). Older patient age [HR 1.15, p < 0.001], prior acute GVHD [1.30, p = 0.024], and RIC [1.36, p = 0.028] increased overall cGVHD. In addition, RIC [4.85, p < 0.001], prior aGVHD [2.14, p = 0.001] and female donor to male recipient [1.80, p = 0.008] increased the risk of severe cGVHD. ATG had a protective effect for both overall [0.41, p < 0.001] and severe cGVHD [0.20, p < 0.001]. Relapse-free survival (RFS) was impaired in patients with severe cGVHD. RIC, prior aGVHD, and female-to-male donation increase the risk of severe cGVHD. ATG reduces the risk of all grades of cGVHD without hampering RFS. GVHD prophylaxis may be tailored according to the risk profile of patients. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 1 | 33% |
Unknown | 2 | 67% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Scientists | 1 | 33% |
Members of the public | 1 | 33% |
Practitioners (doctors, other healthcare professionals) | 1 | 33% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 34 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 6 | 18% |
Other | 6 | 18% |
Professor > Associate Professor | 3 | 9% |
Student > Doctoral Student | 2 | 6% |
Student > Bachelor | 2 | 6% |
Other | 8 | 24% |
Unknown | 7 | 21% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 12 | 35% |
Immunology and Microbiology | 3 | 9% |
Nursing and Health Professions | 2 | 6% |
Unspecified | 2 | 6% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 3% |
Other | 3 | 9% |
Unknown | 11 | 32% |