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Observational Study
. 2015 Feb;21(2):266-74.
doi: 10.1016/j.bbmt.2014.10.021. Epub 2014 Oct 30.

Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research

Sally Arai  1 , Mukta Arora  2 , Tao Wang  3 , Stephen R Spellman  4 , Wensheng He  5 , Daniel R Couriel  6 , Alvaro Urbano-Ispizua  7 , Corey S Cutler  8 , Andrea A Bacigalupo  9 , Minoo Battiwalla  10 , Mary E Flowers  11 , Mark B Juckett  12 , Stephanie J Lee  13 , Alison W Loren  14 , Thomas R Klumpp  15 , Susan E Prockup  16 , Olle T H Ringdén  17 , Bipin N Savani  18 , Gérard Socié  19 , Kirk R Schultz  20 , Thomas Spitzer  21 , Takanori Teshima  22 , Christopher N Bredeson  23 , David A Jacobsohn  24 , Robert J Hayashi  25 , William R Drobyski  26 , Haydar A Frangoul  27 , Görgün Akpek  28 , Vincent T Ho  8 , Victor A Lewis  29 , Robert Peter Gale  30 , John Koreth  8 , Nelson J Chao  31 , Mahmoud D Aljurf  32 , Brenda W Cooper  33 , Mary J Laughlin  34 , Jack W Hsu  35 , Peiman Hematti  12 , Leo F Verdonck  36 , Melhelm M Solh  37 , Maxim Norkin  35 , Vijay Reddy  38 , Rodrigo Martino  39 , Shahinaz Gadalla  40 , Jenna D Goldberg  41 , Philip L McCarthy  42 , José A Pérez-Simón  43 , Nandita Khera  44 , Ian D Lewis  45 , Yoshiko Atsuta  46 , Richard F Olsson  47 , Wael Saber  5 , Edmund K Waller  48 , Didier Blaise  49 , Joseph A Pidala  50 , Paul J Martin  13 , Prakash Satwani  51 , Martin Bornhäuser  52 , Yoshihiro Inamoto  13 , Daniel J Weisdorf  2 , Mary M Horowitz  5 , Steven Z Pavletic  53 ; Graft-vs-Host Disease Working Committee of the CIBMTR
Affiliations
Observational Study

Increasing incidence of chronic graft-versus-host disease in allogeneic transplantation: a report from the Center for International Blood and Marrow Transplant Research

Sally Arai et al. Biol Blood Marrow Transplant. 2015 Feb.

Abstract

Although transplant practices have changed over the last decades, no information is available on trends in incidence and outcome of chronic graft-versus-host disease (cGVHD) over time. This study used the central database of the Center for International Blood and Marrow Transplant Research (CIBMTR) to describe time trends for cGVHD incidence, nonrelapse mortality, and risk factors for cGVHD. The 12-year period was divided into 3 intervals, 1995 to 1999, 2000 to 2003, and 2004 to 2007, and included 26,563 patients with acute leukemia, chronic myeloid leukemia, and myelodysplastic syndrome. Multivariate analysis showed an increased incidence of cGVHD in more recent years (odds ratio = 1.19, P < .0001), and this trend was still seen when adjusting for donor type, graft type, or conditioning intensity. In patients with cGVHD, nonrelapse mortality has decreased over time, but at 5 years there were no significant differences among different time periods. Risk factors for cGVHD were in line with previous studies. This is the first comprehensive characterization of the trends in cGVHD incidence and underscores the mounting need for addressing this major late complication of transplantation in future research.

Keywords: Allogeneic transplant; Incidence; Nonrelapse mortality; cGVHD.

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Figures

Figure 1
Figure 1
In the multivariate analysis, higher risk of cGVHD in the most recent time period (2004-2007 versus 1995-1999, odds ratio (OR)= 1.19, p<0.0001; and 2004-2007 versus 2000-2003, OR= 1.13, p=0.002).
Figure 2
Figure 2
Increased cGVHD incidence when stratified by: a) donor type (HLA identical sibling- HR=1.17; unrelated donor- HR=1.07; cord blood- HR=1.24, all p<0.01; b) graft type (PBSC- HR=1.19; cord blood- HR=1.24, p<0.01); or c) conditioning intensity (myeloablative- HR=1.13; reduced intensity- HR=1.16, p<0.01).
Figure 2
Figure 2
Increased cGVHD incidence when stratified by: a) donor type (HLA identical sibling- HR=1.17; unrelated donor- HR=1.07; cord blood- HR=1.24, all p<0.01; b) graft type (PBSC- HR=1.19; cord blood- HR=1.24, p<0.01); or c) conditioning intensity (myeloablative- HR=1.13; reduced intensity- HR=1.16, p<0.01).
Figure 2
Figure 2
Increased cGVHD incidence when stratified by: a) donor type (HLA identical sibling- HR=1.17; unrelated donor- HR=1.07; cord blood- HR=1.24, all p<0.01; b) graft type (PBSC- HR=1.19; cord blood- HR=1.24, p<0.01); or c) conditioning intensity (myeloablative- HR=1.13; reduced intensity- HR=1.16, p<0.01).
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References

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