Work

362: Incidence and Risk Factors for Chronic Graft-Versus-Host Disease (cGVHD) after Cord Blood Transplantation (CBT)

Year: 2008

Type: article

Abstract: Objective: To evaluate the impact of patient and transplant characteristics on the incidence of cGVHD after CBT. Methods: Retrospective study of all CBT performed at our institution between 1996 and 2007, excluding primary graft failure cases. 114 patients were analyzed. All had high-risk hematologic malignancies; 59% were in complete remission or chronic phase at transplantation. Median age was 37 years (range 18–67) in the adult group (n = 61) and 7 years (range 0.5–17) in the pediatric group (n = 53). Conditioning regimen was myeloablative for 92% of patients. It included TBI in 39%, and ATG in 55%. GVHD prophylaxis was tacrolimus-based (except for 2 patients) with methotrexate (75%) or MMF (19%). 44 patients (39%) received double CB units and 70 (61%) single units. Units were ex-vivo expanded for 20/44 and 9/70 patients, respectively. Median number of infused total nucleated cells (TNC) was 3.5 × 107/kg (1–7) and 4.7 × 107/kg (0.6–56) in the adult and pediatric groups, respectively. cGVHD was defined according to the recent NIH consensus criteria. Risk factors were evaluated by Cox's regression analysis including age, gender, disease status at transplantation, a prior autologous transplant, conditioning regimen, use of ATG in conditioning, GVHD prophylaxis, number of CB units received, number of infused TNC, HLA-A, B, or DRB1 mismatch, and early withdrawal of immunosuppression. Results: With a median follow up of 9 months, 21/114 patients developed cGVHD at a median of 126 days post CBT (range 100–276). 62% of these cases (n = 13) were de Novo. Recipient age was the strongest risk factor with a significantly higher 1-year cumulative incidence in adult patients (31%) compared with pediatric patients (n = 4, 8%), p = 0.002), despite a comparable incidence of grade II-IV (38% and 34%) and III-IV (14% and 10%) acute GVHD; and a superior disease free survival in the pediatric group. In adult patients, a prior autologous transplant (n = 16) was the only significant risk factor, and was associated with a higher incidence (50% versus 23%, p = 0.02). cGVHD was extensive in the majority of adult cases (12/17), yet it was associated with a lower rate of relapse (HR = 0.1, p = 0.07) and mortality (HR = 0.4, p = 0.06) when evaluated as time dependent variable in a landmark analysis starting on post SCT day +100. Conclusions: Recipient age is a significant predictor of cGVHD following CBT. In adult patients, the impact of prior autologous transplant deserves further evaluation.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2007.12.372