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Multicenter Study
. 2018 Apr 25;35(6):79.
doi: 10.1007/s12032-018-1127-2.

Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting

Gabriel Afram  1 , Jose Antonio Pérez Simón  2 , Mats Remberger  3 , Teresa Caballero-Velázquez  2 , Rodrigo Martino  4 , Jose Luis Piñana  4   5 , Olle Ringden  3 , Albert Esquirol  4 , Lucia Lopez-Corral  6 , Irene Garcia  4 , Oriana López-Godino  6 , Jordi Sierra  4 , Dolores Caballero  6 , Per Ljungman  7 , Lourdes Vazquez  6 , Hans Hägglund  8
Affiliations
Multicenter Study

Reduced intensity conditioning increases risk of severe cGVHD: identification of risk factors for cGVHD in a multicenter setting

Gabriel Afram et al. Med Oncol. .

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.

Keywords: ATG; Graft-versus-host disease (GVHD); Risk factor.

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Conflict of interest statement

All authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Chronic GVHD incidence in patients treated with anti-thymocyte globulin (ATG) versus no ATG
Fig. 2
Fig. 2
Risk factor score for developing severe cGVHD including risk factors from multivariate analysis with female donor to male recipient, reduced intensity conditioning (RIC), anti-thymocyte globulin (ATG) and prior acute GVHD
Fig. 3
Fig. 3
Relapse-free survival dependent on severity of chronic GVHD
Fig. 4
Fig. 4
Relapse-free survival in patients conditioned with or without anti-thymocyte globulin (ATG)
See this image and copyright information in PMC

References

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