Can we recognize clinical parameters which are associated with occurrence and severity of graft-versus host disease?
Journal
Bone Marrow Transplantation Journal 2011; 46(Suppl 1): S90–S389
Date Issued
2011
Author(s)
DOI
10.1038/bmt.2011.48
Abstract
The application of allogeneic hematopoetic stem cell transplantation
(HSCT) is limited by life-threatening complications such
as severe or acute graft-versus-host disease (GVHD). Despite
intensive prophylaxis with immunosuppressive agents, the incidence
of GVHD occurs in 9-50% of patients undergoing transplant
with an identical HLA sibling matched donor and 75% of
patients undergoing unrelated HLA donors.
Aim of study: To evaluate our experiences in GVHD prophylaxis
and treatment after alloTHSC, GVHD incidence and prognostic
factors and administration of new immunosuppressive
regiments. Patients and methods: Starting from September 2000 till September
2009, 63 patients (36 males and 27 females) at the age
of 16-56 (median range 33 years) with hematological malignances
were treated with alloTHSC on Department of Hematology,
Clinical Centre, and Skopje. For 55 patients donors were
HLA identical siblings and the rest 8 patients were transplanted
from HLA unrelated donors. In 10 patients bone marrow was
used as source of stem cells and in 53 patients stem cells were
obtained from peripheral blood. From the group of 63 patients,
26 patients have active disease at the time of transplantation.
GVHD prophylaxis was accomplished with combination of
cyclosporine and metothrexate (Seattle regimen) or more intensive
immunosupression regiments.
Results: GVHD was noticed in 30 patients (47,6%) and at 33
patients (52,4%) was not noticed a manifestation of GVHD.
Acute GVHD was noticed in 24 patients (38%) and chronic
GVHD in 20 patients (31,7%) The remaining 32 patients (45%)
achieved complete clinical and hematological remission. Lethal
outcome was confi rmed in 31(49%) patients (9 from chrGVHD,6
from acute GVHD, 16 from disease relapse).
Conclusion: The incidence of acute GVHD in our study was
38% and 31% of chronic GVHD. The most common GVHD
reaction was registered in female donors and male recipients,
with higher GVHD incidence in elderly patients. In all patients
stem cells were obtained from peripheral blood. Active disease,
sex, source of hematopoetic cells, age and conditional regiments
are the most signifi cant predictive factors with the higest
infl uence of incidence of GVHD.
(HSCT) is limited by life-threatening complications such
as severe or acute graft-versus-host disease (GVHD). Despite
intensive prophylaxis with immunosuppressive agents, the incidence
of GVHD occurs in 9-50% of patients undergoing transplant
with an identical HLA sibling matched donor and 75% of
patients undergoing unrelated HLA donors.
Aim of study: To evaluate our experiences in GVHD prophylaxis
and treatment after alloTHSC, GVHD incidence and prognostic
factors and administration of new immunosuppressive
regiments. Patients and methods: Starting from September 2000 till September
2009, 63 patients (36 males and 27 females) at the age
of 16-56 (median range 33 years) with hematological malignances
were treated with alloTHSC on Department of Hematology,
Clinical Centre, and Skopje. For 55 patients donors were
HLA identical siblings and the rest 8 patients were transplanted
from HLA unrelated donors. In 10 patients bone marrow was
used as source of stem cells and in 53 patients stem cells were
obtained from peripheral blood. From the group of 63 patients,
26 patients have active disease at the time of transplantation.
GVHD prophylaxis was accomplished with combination of
cyclosporine and metothrexate (Seattle regimen) or more intensive
immunosupression regiments.
Results: GVHD was noticed in 30 patients (47,6%) and at 33
patients (52,4%) was not noticed a manifestation of GVHD.
Acute GVHD was noticed in 24 patients (38%) and chronic
GVHD in 20 patients (31,7%) The remaining 32 patients (45%)
achieved complete clinical and hematological remission. Lethal
outcome was confi rmed in 31(49%) patients (9 from chrGVHD,6
from acute GVHD, 16 from disease relapse).
Conclusion: The incidence of acute GVHD in our study was
38% and 31% of chronic GVHD. The most common GVHD
reaction was registered in female donors and male recipients,
with higher GVHD incidence in elderly patients. In all patients
stem cells were obtained from peripheral blood. Active disease,
sex, source of hematopoetic cells, age and conditional regiments
are the most signifi cant predictive factors with the higest
infl uence of incidence of GVHD.
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