Incidence and risks for sclerodermatous chronic grafi versus-host disease after allogeneic marrow or bloo1 transplantation

Steven Z. Pavletic, James C. Lynch, Samer Sannoufi, Marsha A. Ketcham, Michael R. Bishop, Stefano Tarantolo, Robert G Bociek, Margaret A. Kessinger

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Abstract

Rationale: Serious manifestations of chronic graft-versus-host disease (cGVHC ) include scleroderma-like skin changes. There is a clinical suspicion that its incidence rniglt be higher after blood (BSCT) rather than marrow (BMT) transplantation. Objective: To determine incidence, risk factors, and outcome of sclerodermatoi s skin cGVHD (S-GVHD) after allogeneic stem cell transplantation (alloSCT). Methods: The records of 149 consecutive patients (pts) with hématologie-4! malignancies who survived 100 days after G-CSF mobilized 6/6 antigen matched relatecl alloSCT (63 BMT, 86 BSCT) were analyzed for the incidence of S-GVHD, defined a|s localized or diffuse skin thickening. All pts received identical GVHD prophylaxis will cyclosporine and methotrexate and 91% received a 1200 cGy TBl-containing preparativî regimen. Front-line cGVHD therapy consisted of cyclosporine and prednisone. Variables analyzed as risk factors for S-GVHD included: pts age and gender, type of malignancy, cytomegalovirus status, donor-recipient gender, stem cell source, TBI or etoposide in the preparative regimen, and acute GVHD (aGVHD). Results: The median follow-up of 82 surviving pts is 43 months (range, 12 to 108 months). Cumulative incidence of skin cGVHD was 60% (91 pts), 28% localized, 32 diffuse. The incidence of S-GVHD was 24% (36 pts), 23β6 (66%) had diffuse ski[i involvement. Prior history of skin aGVHD was the only variable significantly related to the incidence of S-GVHD (p=0.04). Higher stage of skin aGVHD was associated with increasing incidence of S-GVHD (p=0.011 for trend). In contrast, prior lower or upper GI or liver aGVHD (p=0.66, 1.0, and 0.70 respectively), or type of stem cell source (p=0.44) were non predictive for the onset of S-GVHD. Development of S-GVHD was associated with pts who had longer survival, median survival 62 months vs. 38 months (p=0.063). Conclusions: Prior history and clinical stage of aGVHD predict onset of S-GVHD. The incidence of S-GVHD seems to be independent of the stem cell source used for the alloSCT.

Original languageEnglish (US)
Pages (from-to)194a
JournalBlood
Volume96
Issue number11 PART I
Publication statusPublished - Dec 1 2000

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ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Pavletic, S. Z., Lynch, J. C., Sannoufi, S., Ketcham, M. A., Bishop, M. R., Tarantolo, S., ... Kessinger, M. A. (2000). Incidence and risks for sclerodermatous chronic grafi versus-host disease after allogeneic marrow or bloo1 transplantation. Blood, 96(11 PART I), 194a.