Work

Hyperacute GVHD: Analysis of risk factors, clinical manifestations, and outcomes

Year: 2005

Type: article

Abstract: We evaluated the clinical characteristics and risk factors for hyperacute graft-versus-host disease (GVHD) in 815 consecutive patients transplanted at M.D. Anderson Cancer Center between January 1998 and September 2002. Our definition of hyperacute GVHD included all patients with a diagnosis of GVHD within 14 days after allogeneic bone marrow or peripheral blood stem cell transplantation (PSCT). Of 381 patients presenting with clinical evidence of acute GVHD, 22% (n= 83) occurred within 14 days posttransplantation (early GVHD), and were all biopsy-proven. Grade I GVHD occurred in 12% of these patients, grade II in 53%, grade III in 13%, and grade IV in 22%. The proportion of grade II-IV GVHD in this group was significantly higher (88%) than in the 298 patients presenting with GVHD between days 15 and 100 posttransplantation (64%) (P< .001). The majority of patients with early GVHD had skin involvement (89%), followed by gastrointestinal (43%), and liver GVHD (19%). Skin involvement was significantly more common (89% vs 76%; P= .01), and more severe (stage III or IV 63% vs 32%; P< .001) in the early GVHD group. Significantly factors on univariate analysis included a graft from a mismatched (MM) related donor (HR= 4.4; P< .001) or a matched unrelated donor (MUD) (HR= 2.4; P <.001) vs a graft from a matched related donor, and myeloablative preparative regimen with or without total body irradiation (HR= 2.5; P< .001). These effects remained significant when evaluated in a multivariate model. Donor’s age> 40 years was associated with a marginally significant lower rate of early GVHD (HR= 0.6; P= .05), and there was a trend toward increased rates for patients receiving sex-mismatched grafts, patients transplanted for solid tumors, and those having received more than 5 chemotherapy regimens before transplantation. There was no difference in the distribution of CD34+ or CD3+ cells infused. All-cause mortality rate was significantly higher within 6 months posttransplantation for patients with early GVHD (HR= 2.2; P< .001) compared with all other patients or to patients developing acute GVHD after day 14 (HR= 1.6; P= .009). Acute GVHD death rate was also significantly higher (HR= 2.3; P= .007). Hyperacute GVHD occurs in a substantial proportion of patients undergoing HSC transplant, even before neutrophil engraftment. Skin involvement, grades 3–4 GVHD, and higher mortality are common features of this syndrome.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2004.12.031