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Risk factors for moderate‐to‐severe acute graft‐vs.‐host disease after allogeneic stem cell transplantation in children
Author(s) -
Svennilson Johan,
Remberger Mats,
Ringdén Olle
Publication year - 2003
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1034/j.1399-3046.2003.00030.x
Subject(s) - medicine , odds ratio , transplantation , abo blood group system , methotrexate , univariate analysis , logistic regression , human leukocyte antigen , disease , sibling , graft versus host disease , multivariate analysis , retrospective cohort study , gastroenterology , immunology , antigen , psychology , developmental psychology
Severe acute graft‐vs.‐host disease (aGVHD) remains a major cause of transplantation‐related mortality. However, because of a graft‐vs.‐leukaemia effect, a mild (grade I) aGVHD is desirable. As risk factors predisposing for aGVHD are not necessarily the same in children and adults, we have performed a retrospective analysis of risk factors (RFs) for grade II–IV aGVHD in 258 paediatric patients undergoing allogeneic stem cell transplantation at our centre. Thirty‐two potential RFs were assessed with univariate analysis in logistic regression. Eleven factors were selected for further evaluation in stepwise elimination multivariate analysis. Three independent RFs were found: (1) donor other than human lekocyte antigen (HLA)‐identical sibling [odds ratio (OR) 6.1, p < 0.001); (2) single drug [cyclosporine A (CsA) or methotrexate (Mtx)] graft‐vs.‐host disease (GVHD) prophylaxis (OR 7.0, p < 0.001); and (3) ABO disparity of any kind (OR 2.4, p = 0.02). The RFs were additive: moderate‐to‐severe aGVHD was seen in none of the patients without any RFs; in 16% with one RF; in 32% with two RFs and in 67% with all three RFs present. Single drug GVHD prophylaxis (CsA or Mtx), any kind of ABO mismatch, and non‐sibling donors are RFs for grade II–IV acute GVHD in paediatric SCT. We encourage the use of combination GVHD prophylaxis in children. ABO mismatch should be considered when choosing between otherwise equally suitable donors.