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Jerzy Wojnar, Sebastian Giebel, Aleksandra Holowiecka-Goral, Malgorzata Krawczyk-Kulis, Miroslaw Markiewicz, Krzysztof Wozniczka
Ann Transplant 2006; 11(2): 14-20
Objectives: Chronic graft-versus-host-disease (cGVHD) deteriorates survival and quality of life after allogeneic hematopoietic cell transplantation (alloHCT). We evaluated the incidence and risk factors for this complication based on a single-center experience. Methods: 255 consecutive patients, aged 29 (10-56) years, who survived without disease progression after alloHCT performed between 1992- 2003 were included in the analysis. The preparative regimen was myeloablative, donors were either related (n=177) or unrelated volunteers (URD-HCT) (n=78). Results: Cumulative incidence of the overall and extensive cGVHD equaled 48% and 22%, respectively. In a multivariate analysis the following factors were associated with increased risk of cGVHD: preceding grade II-IV acute GVHD, recipient age ≥40 years, URD-HCT, the diagnosis of chronic myeloid leukemia (CML) or myelodysplastic syndrome, and CD3 cell dose ≥ 50×106/kg. Similar factors, excluding recipient age contributed to increased risk of extensive cGVHD, however, the cut-point for CD3 cell dose was 100×106/kg and the use of steroids for acute GVHD prophylaxis was found an additional risk factor. In a CML subgroup the risk of cGVHD was increased for patients previously treated with interferon. Conclusions: Various recipient-, donor-, and procedure-related factors are related to the risk of cGVHD. Individualized treatment and modification of risk factors may contribute to improved outcome.