Risk Factors for Acute Graft-Versus-Host Disease After Allogeneic Haematopoietic Stem Cell Transplantation: A Single-Center Experience
Feiyan Wang, Bo Cai, Li Wang, Zhenyang Gu, Lan Luo, Huaping Wei, Shasha Zhao, Lixun Guan, Xiaoyu Wang, Lili Wang, Daihong Liu, Chunji Gao
(Department of Haematology, Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China (mainland))
Ann Transplant 2017; 22:58-65
Acute graft-versus-host disease (aGVHD) remains the most common and challenging complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). An important obstacle to the therapeutic effect of aGVHD is the inability to identify risk factors for an individual patient at the onset of symptoms. We performed a retrospective study with the aim of defining clinically meaningful pre-transplantation risk factors for grades II-IV aGVHD patients.
MATERIAL AND METHODS: To identify pre-transplantation risk factors for grades II-IV aGVHD after allo-HSCT, we performed a retrospective study in 292 patients who underwent allo-HSCT at our center from January 2010 to July 2015.
RESULTS: The cumulative incidence of grades II–IV aGVHD was 36.6±2.8%. The most common target organ of aGVHD was the skin (46.7%), followed by the gastrointestinal tract (29.9%). The risk factors we identified included HLA-mismatched related donors (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.82–5.67) and conditioning regimens containing TBI but no ATG (OR, 2.66; 95% CI, 1.40–5.06). Simultaneously, transplantation with an identical sibling donor (OR, 0.31; 95% CI, 0.18–0.55) and the use of ATG in the conditioning regimen containing TBI (OR 0.37; 95% CI, 0.15–0.93) were two factors found to be associated with a decreased risk of grades II–IV aGVHD.
CONCLUSIONS: Our study suggests that pre-transplantation characteristics of donor and recipient play an important role in identifying patients at high risk for grades II–IV aGVHD, which provide a direction for the prevention and treatment of aGVHD in the future.
Keywords: Graft vs Host Disease, Risk Factors, Transplantation, Homologous