Risk Factors For Steroid-Refractory Acute Graft-Versus-Host Disease After Allogeneic Stem Cell Transplantation From Matched Related Or Unrelated Donors

• Published in: Blood 2013-11, Vol.122 (21), p.4595-4595
• Main Authors: Calmettes, Claire, Vigouroux, Stephane, Tabrizi, Reza, Pigneux, Arnaud, Leguay, Thibaut, Bouabdallah, Krimo, Dilhuydy, Marie-Sarah, Duclos, Cedric, Lascaux, Axelle, Dumas, Pierre-Yves, Dimicoli-Salazar, Sophie, Marit, Gerald, Milpied, Noel
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V122.21.4595.4595

The standard risk factors for acute graft-versus-host disease (aGVHD) after allogeneic stem cell transplantation (allo-SCT) from related or unrelated donors are well defined and include HLA mismatch or unrelated donor, older recipient age, and female donor for male recipient (FM). The steroid-refractory (SR) forms of aGVHD are important to consider because they often have a major deleterious impact on transplant outcome. Unfortunately, the specific risk factors for SR aGVHD are less clearly defined. To characterize these risk factors after allo-SCT from matched related or unrelated donors, we undertook a retrospective analysis of adult patients transplanted at our center between 01/01/2000 and 12/31/2012. Steroid-refractory aGVHD was defined as aGVHD progressing after 3 days of treatment, or unchanged after 7 days, or in incomplete response after 14 days. GVHD occurring after donor lymphocytes infusion were excluded. Overall survival (OS) was calculated using the Kaplan-Meier estimate. Cumulative incidences (CI) were used for SR aGVHD in a competing risk setting with death as a competing event. The Gray test was used to compare CI curves. For multivariate analysis, the variables with p value < 0.1 were entered into a Fine-Gray model and the least significant variables were excluded in sequential fashion until all remaining factors were significant at the p=0.05 level. The variables considered were recipient age (≥ vs < 50 years, median age), female vs male donor, FM vs other combinations, matched related (MRD) vs matched unrelated donor (MUD), peripheral blood (PB) vs bone marrow (BM) graft, GVHD prophylaxis with cyclosporine (CsA)+metho vs others, myeloablative (MAC) vs reduced-intensity conditioning (RIC) regimen, antithymocyte globulin (ATG) vs no ATG, number of CD34+ cells in the graft ≥ vs< 5.6 x 106/kg (median number), early (CR1, PR1, chronic phase, or untreated) vs advanced disease, CMV-seropositive vs seronegative recipient. Unrelated donors were matched at the allele level for HLA-A, B, C, DRB1, DQB1. Six hundred and thirty four patients were identified and included in the present study. The median age was 50 years (18-67). Diseases were AML (n=230), ALL (n=104), myeloma (n=80), NHL (n=74), Hodgkin's disease (n=18), MDS (n=47), CLL (n=29), CML (n=18), aplastic anemia (n=19), and MPS (n=15). Status at transplant were CR1 or PR1 or chronic phase (n=260), > CR1 or PR1 (n=237), refractory (n=101), or untreated (n=36). Conditioning regimens were RIC (