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Comparative Study
. 2011 Mar 17;117(11):3214-9.
doi: 10.1182/blood-2010-08-302109. Epub 2011 Jan 24.

Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteria

Mary E D Flowers  1 , Yoshihiro Inamoto, Paul A Carpenter, Stephanie J Lee, Hans-Peter Kiem, Effie W Petersdorf, Shalini E Pereira, Richard A Nash, Marco Mielcarek, Matthew L Fero, Edus H Warren, Jean E Sanders, Rainer F Storb, Frederick R Appelbaum, Barry E Storer, Paul J Martin
Affiliations
Comparative Study

Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteria

Mary E D Flowers et al. Blood. .

Abstract

Risk factors for grades 2-4 acute graft-versus-host disease (GVHD) and for chronic GVHD as defined by National Institutes of Health consensus criteria were evaluated and compared in 2941 recipients of first allogeneic hematopoietic cell transplantation at our center. In multivariate analyses, the profiles of risk factors for acute and chronic GVHD were similar, with some notable differences. Recipient human leukocyte antigen (HLA) mismatching and the use of unrelated donors had a greater effect on the risk of acute GVHD than on chronic GVHD, whereas the use of female donors for male recipients had a greater effect on the risk of chronic GVHD than on acute GVHD. Total body irradiation was strongly associated with acute GVHD, but had no statistically significant association with chronic GVHD, whereas grafting with mobilized blood cells was strongly associated with chronic GVHD but not with acute GVHD. Older patient age was associated with chronic GVHD, but had no effect on acute GVHD. For all risk factors associated with chronic GVHD, point estimates and confidence intervals were not significantly changed after adjustment for prior acute GVHD. These results suggest that the mechanisms involved in acute and chronic GVHD are not entirely congruent and that chronic GVHD is not simply the end stage of acute GVHD.

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Figures

Figure 1
Figure 1
Cumulative incidence of grades 2-4 acute GVHD (top panel) and NIH chronic GVHD (bottom panel).
Figure 2
Figure 2
Multivariate risk factor profiles for grades 2-4 acute GVHD and NIH chronic GVHD. Hazard ratio and 95% CI for each risk factor are shown. The analysis included 2355 grades 2-4 acute GVHD events and 1022 NIH chronic GVHD events. Hazard ratios are relative to patients without the risk factor.
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Comment in

References

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