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Chronic graft‐ versus ‐host disease after allogeneic bone marrow transplantation from an unrelated donor: incidence, risk factors and association with relapse. A report from the Japan Marrow Donor Program
Author(s) -
Ozawa Shinichi,
Nakaseko Chiaki,
Nishimura Miki,
Maruta Atsuo,
Cho Ryuko,
Ohwada Chikako,
Sakamaki Hisashi,
Sao Hiroshi,
Mori Shinichiro,
Okamoto Shinichiro,
Miyamura Kouichi,
Kato Shunichi,
Kawase Takakazu,
Morishima Yasuo,
Kodera Yoshihisa
Publication year - 2007
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.2007.06543.x
Subject(s) - medicine , cumulative incidence , graft versus host disease , transplantation , incidence (geometry) , total body irradiation , bone marrow , immunology , surgery , gastroenterology , chemotherapy , cyclophosphamide , physics , optics
Summary Chronic graft‐ versus ‐host disease (GVHD) remains the major cause of late morbidity and mortality after allogeneic stem cell transplantation. We retrospectively analysed 2937 patients who underwent bone marrow transplantation from an unrelated donor (UR‐BMT) facilitated by the Japan Marrow Donor Program (JMDP) and survived beyond day 100 after transplantation. The cumulative incidence of chronic GVHD (limited + extensive) or extensive chronic GVHD at 5 years post‐transplant was 45·8% and 28·2%, respectively. On multivariate analysis, seven variables predicting chronic GVHD were identified: recipient age over 20 years, donor age over 30 years, primary diagnosis of chronic myeloid leukaemia, human leucocyte antigen (HLA)‐A or ‐B mismatch, total body irradiation‐containing regimen, platelet count not having reached 50 × 10 9 /l by day 100, and prior acute GVHD. Among 2609 patients with haematological malignancy, overall survival was significantly higher in patients with limited chronic GVHD but lower in patients with extensive chronic GVHD compared with those without chronic GVHD. The cumulative incidence of relapse among patients with limited or extensive chronic GVHD was significantly lower than that among patients without chronic GVHD. Our results suggest that limited chronic GVHD provides a survival benefit to patients with haematological malignancies by reducing the risk of relapse without increasing the risk of death from chronic GVHD.