Risk of De Novo GVHD in Marrow Graft Recipients
De Novo Chronic Graft-Versus-Host Disease in Marrow
Graft Recipients Given Methotrexate and Cyclosporine:
Risk Factors and Survival
Biology of Blood and Marrow Transplantation 6:633-639 (2000)
© 2000 American Society for Blood and Marrow Transplantation
John L.Wagner, Kristy Seidel, Michael Boeckh, Rainer Storb
A retrospective study was performed to determine risk factors for the development of de novo chronic graft-versus-host
disease (GVHD) in patients given marrow grafts from HLA-identical sibling donors (85%), HLA-nonidentical
family members (3%), or HLA-matched unrelated donors (12%) and for postgrafting immunosuppression with
methotrexate and cyclosporine. We also examined the impact of chronic GVHD on survival and identified patients at
low risk for chronic GVHD in whom immunosuppression might be stopped safely early after transplantation. Among
489 patients with either grade 0 or I acute GVHD, 33% developed chronic GVHD. Overall survival was 70%, and
relapse-free survival was 63% at 8 years. Risk factors for chronic GVHD were found to include donor buffy coat infu-sions
among patients given transplants for aplastic anemia (relative risk [RR] = 2.9, P = .05), patient-donor sex/parity
combination (likelihood ratio test, P < .001), grade I acute GVHD (RR = 1.6, P = .003), and active cytomegalovirus
infection (RR = 1.5, P = .05) before day 60. Among 45 patients aged <19 years who had male donors, only 1 developed
chronic GVHD. This group had an overall survival rate of 65% and a relapse-free survival rate of 54% at 8 years post-transplantation - a result not better than that among the entire cohort. The lack of improvement in survival in the
low-risk group was related to a high rate of relapse of the underlying diseases. Therefore, the development of de
novo chronic GVHD does not have a negative impact on patient survival; the adverse effect from increased transplantation-related complications is offset by a lower relapse rate, the result of an allogeneic graft-versus-tumor effect.
 6.6.Wagner
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