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Clinical Trial
. 2013 Oct;48(10):1285-90.
doi: 10.1038/bmt.2013.48. Epub 2013 Apr 15.

Characteristics of chronic GVHD after cord blood transplantation

L F Newell  1 , M E D Flowers, T A Gooley, F Milano, P A Carpenter, P J Martin, C Delaney
Affiliations
Clinical Trial

Characteristics of chronic GVHD after cord blood transplantation

L F Newell et al. Bone Marrow Transplant. 2013 Oct.

Abstract

Most reports of chronic GVHD after cord blood transplantation (CBT) have utilized traditional diagnostic criteria. We used traditional criteria and National Institutes of Health (NIH) criteria prospectively to evaluate chronic GVHD in a cohort of 87 adult and pediatric recipients of single or double unrelated CBT for treatment of hematologic malignancies. Fifty-four patients developed traditionally defined chronic GVHD, for an estimated 2-year probability of 64%. Among 54 patients, 25 (46%) met the NIH criteria for persistent, recurrent or late acute GVHD at onset. Twenty-four (44%) had overlap chronic GVHD, including one who presented initially with late acute GVHD, and only seven (13%) had classic chronic GVHD, including one who also presented initially with late acute GVHD. Among patients who successfully discontinued all systemic immunosuppression (SI), the median time to discontinuation of corticosteroid treatment was 315 days (range 28-977), and the median time to discontinuation of all SI was 353 days (range 67-977). Chronic GVHD diagnosed by traditional criteria after CBT had a predominance of acute GVHD clinical features.

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Conflict of interest statement

Conflict-of-Interest Disclosure

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Estimated Probability of Acute (panel A) and Chronic (panel B) GVHD after Cord Blood Transplant (CBT)
Among the 87 patients cohort, 75% developed grades II-IV and 30% developed grades III-IV acute GVHD prior to day 80–100 after transplantation. Of the 54 patients with any chronic GVHD by traditional criteria, 25 presented with “late acute” GVHD and 31 patients with NIH-defined chronic GVHD.
Figure 2
Figure 2. Sites of Chronic GVHD at Any Time and According to the NIH Categories
The gastrointestinal tract was the most common site in patients with any chronic GVHD, “late acute” GVHD and overlap subtype of chronic GVHD. The classic subtype of chronic GVHD predominately involved the mouth and skin.
Figure 3
Figure 3. Probability of Discontinuation of Immunosuppression for Chronic GVHD
Among the 54 patients with any chronic GVHD, 18 successfully discontinued all immunosuppression. Of the patients unable to discontinue immunosuppression, 21 were alive without relapse and 15 died while on immunosuppression.
See this image and copyright information in PMC

References

    1. Barker JN, Weisdorf DJ, Defor TE, Blazar BR, McGlave PB, Miller JS, et al. Transplantation of 2 partially HLA-matched umbilical cord blood units to enhance engraftment in adults with hematologic malignancy. Blood. 2005;105(3):1343–1347. - PubMed
    1. MacMillan ML, Weisdorf DJ, Brunstein CG, Cao Q, Defor TE, Verneris MR, et al. Acute graft-versus-host disease after unrelated donor umbilical cord blood transplantation: analysis of risk factors. Blood. 2009;113(11):2410–2415. - PMC - PubMed
    1. Laughlin MJ, Eapen M, Rubinstein P, Wagner JE, Zhang MJ, Champlin RE, et al. Outcomes after transplantation of cord blood or bone marrow from unrelated donors in adults with leukemia. N Engl J Med. 2004;351(22):2265–2275. - PubMed
    1. Brunstein CG, Laughlin MJ. Extending cord blood transplant to adults: dealing with problems and results overall (Review) Semin Hematol. 2010;47(1):86–96. - PubMed
    1. Brunstein CG, Gutman JA, Weisdorf DJ, Woolfrey AE, Defor TE, Gooley TA, et al. Allogeneic hematopoietic cell transplantation for hematological malignancy: relative risks and benefits of double umbilical cord blood. Blood. 2010;116(22):4693–4699. - PMC - PubMed

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