Risk Factors for Graft-Versus-Host Disease After Transplantation of Hematopoietic Stem Cells from Unrelated Donors in the China Marrow Donor Program

Abstract

BACKGROUND We identified risk factors for acute and chronic graft-versus-host disease (aGVHD and cGVHD, respectively) in recipients after hematopoietic stem cell transplantation (HSCT) from unrelated donors in the China Marrow Donor Program (CMDP). MATERIAL AND METHODS We analyzed follow-up clinical information from 1824 patients who underwent HSCT between 2001 and 2010. RESULTS The incidence of aGVHD and cGVHD after transplantation was 49.29% and 27.3%, respectively. aGVHD incidence decreased as HLA matching increased (p<0.001). Incidence of aGVHD and cGVHD was higher in 2 HLA-A locus donor/recipient groups (02: 01/02: 06 and 02: 01/02: 07; p≤0.022). aGVHD incidence was associated with patient age, absence of rabbit anti-thymocyte globulin (ATG) pretreatment, and disease status (p≤0.040). aGVHD appeared to be a risk factor for cGVHD, and total body irradiation (TBI) was also associated with cGVHD. Patients with cGVHD after transplantation had a higher survival rate than patients without cGVHD (p<0.001), which may be due to reduced relapse rates. Survival was also associated with ATG prophylaxis and disease status. CONCLUSIONS The incidence of GVHD after HSCT from unrelated donors in the Chinese population is similar to the results reported from other countries. A high degree of HLA matching, a conditioning regimen without TBI, and the use of ATG may reduce the incidence of aGVHD.

Figure 1

Proportion of patients who died at last follow-up by disease status for a given diagnosis.

Figure 2

Kaplan-Meier survival curve by disease status for given disease diagnosis. AML (A), ALL (B), CML (C), MDS (D), NHL, HAL, MM, CMML, CLL (E), and others (F).

Figure 3

Kaplan-Meier curve of event-free survival (EFS) time of patients (n=1617). The events included all transplant-related deaths.

Figure 4

Kaplan-Meier curve of event-free survival (EFS) time of patients by aGVHD status. The events included all transplant-related deaths.

Figure 5

Kaplan-Meier curve of relapse-free survival of patients by aGVHD (A) and cGVHD (B) status. The events included all cases of relapse after transplantation. The estimated mean relapse time was 77.1 months (95% CI, 74.7–79.5 months) and 79.4 months (95% CI, (76.5–82.3 months) for the aGVHD and non-aGVHD groups, respectively (p=0.508). The estimated mean relapse time was 71.6 (95% CI, 69–74.1 months) and 78.8 months [95% CI, 76.4–81.2 months) for the cGVHD and non-cGVHD groups (p<0.001).