Work

196: Acute Graft-Versus-Host Disease (AGVHD) in Unrelated Cord Blood Transplantation (UCBT): Single Institution Experience, July 1996 – June 2007

Year: 2008

Type: article

Abstract: UCBT has been associated with a lower incidence of GVHD when compared to unrelated transplant using adult donors. However, the characteristics (sites, time to onset, course, and tolerability) of GVH following UCBT has not been as clearly elucidated. We review GVH in 81 consecutive UCBT treated on a single therapeutic trial with consistenet GVH prophylaxis. 13 patients were unevaluable based on death prior to UCB infusion (2), death prior to engraftment (7), or graft rejection (4). Thus, 68 patients were evaluable for AGVHD (41 male, 27 female; median age 6.8 yr (range, 0.3–24.4 yr); median weight 22 Kg (range, 5.35–82.9 Kg)). Diagnoses included leukemia in 75% (63% ALL, 25% AML, 12% CML or JMML), MDS 3%, lymphoma 1%, metabolic disorders 6%, immune/genetic disorders 9%, and aplastic anemia 6%. Acute leukemia disease status at UCBT was CR1 24%, CR2 47%, CR3 or greater 18%, and not in remission in 11%. The median TNC infused was 4.06 × 10 7/kg (range, 0.73–28 × 10 7/kg), median CD34 cells infused 2.3 × 10 5/kg (range, 0.3–31.7 × 10 5/kg). HLA matching was 6/6 (23), 5/6 (31), and 4/6 (14). Conditioning was TBI-based in 66% and non-TBI in 34%. GVHD prophylaxis was cyclosporine and steroids in 91%, cyclosporine and Methotrexate +/- steroids in 7%, and other in 2%. Median engraftment times were 23.5 days for neutrophils and 65 days for platelets. Acute GVHD had a median day of onset of 25 days (range, 10–93 days), with grade II-IV seen in 49% and grade III-IV in 25% of patients. The pattern of organ involvement with GVHD is shown in the TableTable below. Isolated GI involvement was seen in 23% of patients with grade III-IV acute GVHD. Event free survival at 1 and 2 yr were 62% and 58% for patients without acute GVHD, 75% and 56% for grade II only, and 53% and 47% for grade III-IV acute GVHD. Survival with higher grade GVHD may be related to both the more delayed onset of GVHD and more manageable course of GVHD after UCBT.Tabled 1Pattern of organs involved by acute GVHDOrgan system involved (%)Acute GVHD maximum gradeNo. of patientsLiverGISkinGrade I300100%Grade II166%50%87%Grade III1216%100%66%Grade IV580%100%100%Total36 Open table in a new tab

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.205