Characterization of acute graft-versus-host disease following reduced-intensity stem-cell transplantation from an HLA-identical related donor
✍ Scribed by Naoko Murashige; Masahiro Kami; Shin-ichiro Mori; Yuta Katayama; Kazuhiko Kobayashi; Yasushi Onishi; Akiko Hori; Yukiko Kishi; Tamae Hamaki; Kinuko Tajima; Yoshinobu Kanda; Ryuji Tanosaki; Yoichi Takaue
- Publisher
- John Wiley and Sons
- Year
- 2008
- Tongue
- English
- Weight
- 109 KB
- Volume
- 83
- Category
- Article
- ISSN
- 0361-8609
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✦ Synopsis
Abstract
To investigate clinical features of acute graft‐versus‐host disease (GVHD) following reduced intensity stem‐cell transplantation (RIST), we retrospectively investigated medical records of 65 patients with hematologic malignancies who underwent RIST from a matched related donor. Preparative regimen comprised fludarabine 30 mg/m^2^ (n = 53) or cladribine 0.11 mg/kg (n = 12) for 6 days plus busulfan 4 mg/kg for 2 days. Twelve patients received rabbit antithymocyte globulin 2.5 mg/kg/day for 2–4 consecutive days. Grade II to IV acute GVHD was diagnosed in 36 patients (55%). Its median onset was day 58 (range, 17–109), while it was bimodal, peaking day 15–29 (early‐onset GVHD, n = 18) and day 75–89 days (late‐onset GVHD, n = 18). Variables that were more common in early‐onset GVHD than late‐onset GVHD included skin rash (89% vs. 61%) and noninfectious fevers (33% vs. 11%). Desaturation, pulmonary infiltrates and hyperbilirubinemia (>2.0 mg/dL) were more common in late‐onset GVHD (6% vs. 22%, 0% vs. 17%, and 6% vs. 33%, respectively). All of the patients with early‐onset GVHD given corticosteroid responded to it, while 5 of the 18 patients with late‐onset GVHD failed to respond it. Patients with either early‐onset or late‐onset GVHD tended to have better progression‐free survival (PFS) than those without it; however, there was no significant difference in PFS between patients with early‐onset GVHD and those with late‐onset GVHD. This study suggests that several etiologies might have contributed to the development of acute GVHD following RIST. Am. J. Hematol., 2008. © 2008 Wiley‐Liss, Inc.