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Characterization of acute graft‐versus‐host disease following reduced‐intensity stem‐cell transplantation from an HLA‐identical related donor
Author(s) -
Murashige Naoko,
Kami Masahiro,
Mori Shinichiro,
Katayama Yuta,
Kobayashi Kazuhiko,
Onishi Yasushi,
Hori Akiko,
Kishi Yukiko,
Hamaki Tamae,
Tajima Kinuko,
Kanda Yoshinobu,
Tanosaki Ryuji,
Takaue Yoichi
Publication year - 2008
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21197
Subject(s) - medicine , busulfan , fludarabine , gastroenterology , graft versus host disease , transplantation , hematopoietic stem cell transplantation , rash , regimen , surgery , chemotherapy , cyclophosphamide
To investigate clinical features of acute graft‐versus‐host disease (GVHD) following reduced intensity stem‐cell transplantation (RIST), we retrospectively investigated medical records of 65 patients with hematologic malignancies who underwent RIST from a matched related donor. Preparative regimen comprised fludarabine 30 mg/m 2 ( n = 53) or cladribine 0.11 mg/kg ( n = 12) for 6 days plus busulfan 4 mg/kg for 2 days. Twelve patients received rabbit antithymocyte globulin 2.5 mg/kg/day for 2–4 consecutive days. Grade II to IV acute GVHD was diagnosed in 36 patients (55%). Its median onset was day 58 (range, 17–109), while it was bimodal, peaking day 15–29 (early‐onset GVHD, n = 18) and day 75–89 days (late‐onset GVHD, n = 18). Variables that were more common in early‐onset GVHD than late‐onset GVHD included skin rash (89% vs. 61%) and noninfectious fevers (33% vs. 11%). Desaturation, pulmonary infiltrates and hyperbilirubinemia (>2.0 mg/dL) were more common in late‐onset GVHD (6% vs. 22%, 0% vs. 17%, and 6% vs. 33%, respectively). All of the patients with early‐onset GVHD given corticosteroid responded to it, while 5 of the 18 patients with late‐onset GVHD failed to respond it. Patients with either early‐onset or late‐onset GVHD tended to have better progression‐free survival (PFS) than those without it; however, there was no significant difference in PFS between patients with early‐onset GVHD and those with late‐onset GVHD. This study suggests that several etiologies might have contributed to the development of acute GVHD following RIST. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.